PGP Application Form 2014

8/12/2019 PGP Application Form 2014

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INDIAN INSTITUTE OF MANAGEMENT CALCUTTAPost Graduate Diploma in Management (PGDM)Post Graduate Diploma in Computer Aided Management (PGDCM)

Application Form for Personal Interview (PI)/Written Ability Test (WAT)2014

Please tick ( ) the programme(s) you have been short-listed for:

PGDM PGDCM

CAT Registration No.:

1. Name: ________________________________________________________________________________(In CAPITAL LETTERS, as recorded in your school leaving certificate)

Category ( ) : General SC ST DA+ NC-OBC NC-OBC Minority

(If NC-OBC, NC-OBC Minority, SC, ST or DA, attach necessary certificates)

If NC-OBC/NC-OBC Minority, mention name of the Castes/Sub-Castes/Communities

State Entry No.^ (Please follow:http://ncbc.nic.in/backward-classes/index.html)

Date of BirthMarital Status ( ): Gender ( ): Nationality ( ):

Single Married Male Female Indian OthersDD MM YYYY

Name of the city you are appearing for Interview

Present Mailing Address:

Pin code:

Landline No.: Mobile No.:

E-mail ID:

Permanent Address:

Pin code:

Landline No.: Mobile No.:

E-mail ID:

Guardians Name: _________________________________________________ Relationship: ______________

Fathers Name: _______________________________ Mothers Name: _______________________________

Education Occupation Designation Annual Income (Rs.)

Father

Mother

Annual Income of the Applicant*(Rs.): ________________________________ Financial Year: _____________

Annual Income of Family including the Applicant*(Rs.): ___________________ Financial Year: ____________

_________________________________________________________________________________________+Differently Abled^Central List of NC-OBC by the National Commission of Backward Classes, GoI as on last day of CAT 2013 registration will be used.

Any subsequent changes will not be effective for this year admission process. Please fill-in the Entry No. & Caste/Sub- Castes/Communities Boxes above.

*Applicants income should include variable and fixed income if employed. Please ensure the validity of self and family incomestatements as they may be subject to verification for internal administration.

RS

Please affix aself attested

recentpassport size

photograph


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ACADEMIC RECORD

1. Pre-Bachelor Degree Examination: (Bring self attested copies of the final mark-sheet/certificates)Stream during classes 11 12: ________________________________________________________________

ClassName of the School / Board

& UniversityYear ofPassing

Total MaximumMarks

MarksObtained

Percentage Division

10th

12th

(For computing percentages of marks obtained in SSC or equivalent and HSC or equivalent examination,the aggregate marks of all subjects that appear in the mark sheet/grade sheet would be considered)

2. Bachelors Degree Examination: (Bring self attested copies if completed)A. Discipline ( ): Arts Commerce Engineering Science Others

If Others, please specify: _____________________________________________________________________

Specialization in Bachelors Degree: _____________________________________________________________

B. Bachelors Degree Examination Details: (Bring attested copies from Registrar/Principal/Director/Head of theInstitute if not completed)

If not completed, produce a certificate from the college/institution certifying that you have obtained at least50% marks or equivalent (45% in case of candidates belonging to SC, ST and DA category) based on thelatest available grade/marks. The proforma of the certificate is enclosed.

DegreeName of College/

Institute & UniversityYear Total Maximum

Marks/CGPA

Total Marks/

CGPA ObtainedPercentage Class

From To

Total

Expected date of completion of final examination including practical/viva/assignments/projects: _____________

3. Masters Degree Examination:A. Discipline ( ): Arts Commerce Engineering Science Others

If Others, please specify: _____________________________________________________________________

Specialization in Masters Degree: ______________________________________________________________

B. Masters Degree Examination Details:(Bring self attested copies of all mark-sheets received so far)

DegreeName of College/

Institute & UniversityYear Total Maximum

Marks/CGPATotal Marks/

CGPA ObtainedPercentage Class

From To

Total

Expected date of completion of final examination including practical/viva/assignments/projects: _____________

4. Other Professional Degree/Diploma (if completed): __________________________________


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WorkExperience:(UptoJanuary31,

2014inchronologicalorder.

Pleaseattachaseparatesheetif

required)

Donotincludetraining/project

work/workdoneasanintegralpa

rtofcurricularrequirement.State

workexperienceafterGraduationonly.

Attachcopiesof

experiencecertificatesorfirst&

lastpayslips.

Incaseyouareself

-employedoremployedinafamily

businessorinacompanynotlistedinNSEorBSE,attach

anotedetailingthebusiness(includingturnoverandprofit)andthenatureofyourexperience.

REASONSFORLEAVING

T t l W

k E

i

J

3 1 2 0 1 4

( i

t h &

d

)

TOTALSALARY

(PERMONTH)

DURATION

Days

Months

JO

BPROFILE

DESIGNATION

ORGANISATION


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Extra Curricular Activities in College/University:

Nature of Activity Honours/Award & Prizes, if any

Extra Curricular Activities at District/State/National Level:

Nature of Activity Level* Honours/Award & Prizes, if any

* Mention District/State/National Level

List out your hobbies (not more than two) with brief description:

1.

2.


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Career Goals: (Do not write more than 100 words):

Academic Distinctions/Prizes/Awards/any other useful information:

Sl. No. Title Year

1

2

3

4

5

DECLARATION:

I declare that the information given by me in this application form is true and complete in allrespects to the best of my knowledge. I understand that suppression of facts or falseinformation may lead to rejection of my application at any stage of the selection process. I also

understand that the decision of IIM Calcutta in any matter related to the selection process isfinal and binding upon me.

_______________________ ______________________ ________________________Place Date Signature of Applicant


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IINNSSTTRRUUCCTTIIOONNSS

1. This Application Form should be duly filled-in and must be handed over to the interview panel duringthe interview.

2. The CAT 2013 Score Card must be produced for verification. You also need to bring at leastone acceptable form of photo-identification. Acceptable forms of valid photo identificationare valid Drivers license, Passport, PAN Card, Voter ID, Employee identification card, or a

notarized Affidavit with Photo, Signature, Date of Birth and Residential Address.

3. Please affix a self attested recent passport size photograph.4. NC-OBC/SC/ST candidates are required to submit a certificate (proforma enclosed) duly signed by the

competent authority along with the application form. Candidates are also required to bring the originalcertificate for verification at the time of interview. Only certificates issued by competentauthorities designated by the State/UT/Central Government will be considered.

5. Differently Abled (DA) candidates are required to submit a certificate (proforma enclosed) duly signed

by the competent authority as per the Persons with Disability (PWD) Act 1995. Candidates are alsorequired to bring the original certificate for verification at the time of interview.

6. Please ensure the correctness of the self and family income statements as they may be subject toverification for internal administration.

7. All the original academic certificates/mark-sheets must be produced at the time of interview forverification.

8. Please bring self attested copies of all mark-sheets and certificates. Candidates who have already

completed their graduation are advised to submit the self attestedphotocopies of their mark sheets,degree and other certificates. Candidates who are pursuing their graduation or yet to complete theirGraduation/Post Graduation/Professional Qualification are advised to get their mark sheets attested

by the Registrar, Principal, Director or Head of the Department of the Institute.

9. Necessary evidence (Certified record of experience or first and last pay slips) in support of work

experience must be attached along with the application form and the original documents must beproduced at the time of interview. Please note that Appointment Letter will not be consideredas joining date in lieu of first salary slip. If evidence of work experience is not producedduring the interview, the work experience will be taken as NIL.

10. Necessary evidence must be produced in support of extra curricular activities at the time of interview.

11. Wherever letter/point grades are used, corresponding percentage equivalents should be provided. Acertificate from the relevant University/Institute must be enclosed indicating the conversion formula. If

such a conversion is not possible, mention it below the marks columns and enclose a certificate fromthe relevant University/Institute to that effect.

12. This Application Form and proforma of certificates can also be downloaded from IIM Calcutta websitewww.iimcal.ac.in.
http://www.iimcal.ac.in/http://www.iimcal.ac.in/http://www.iimcal.ac.in/

PGP Application Form 2014

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Transcript of PGP Application Form 2014