Application eForm

Internship Program

Affix Passport Photo Here (Note: max pixel size:200px)

INSTRUCTIONS: Please answer each question clearly and completely. Type and email E-FORM to learningacademy@rsolutions-india.com Read carefully and follow all directions. If you need more space, use additional pages. Please affix/paste recent passport-size photograph above.

1. Family name (Surname):

First name:

Middle name:

Gender:

2. Date of Birth: (DD-MM-YYYY):

3(a). Nationality:

3(b). Passport No/Aadhar No:

4. Program Name:

5. Permanent address:

Telephone No.
Email Address
Domicile

Present address if different from that indicated in box 5:

Telephone No.

7. Preferred Mode of Fee Payment. Please give accurate option details:
(Cash/Checks/Debit cards/Credit cards/Mobile payments/Electronic bank transfers, etc)

One or Two Installments or Monthly Installments:

8. ICT skills:

9. Languages Spoken and Written:

10. Education: Note Below - Please give exact titles of two recent degrees. University or equivalent (most recent first) of the educational institutions you have attended and other specialized courses. Give the exact name of institution and title of degrees, diplomas, etc. in English (Please do not translate or equate to other degrees.)
University	Country	Degree Level	Certificates, Diplomas or Degrees and Academic Distinctions Obtained	Score	Year

11. Current employment record: Specify details of atleast two recent jobs
From (Month/Year)	To (Month/Year)	Name of School/Institution	Exact job title	Brief duties

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Undertaking:
All information is authentic. I agree to abide by the course policies and institutional/faculty guidelines to qualify for the course. E-sign