APPLICATION FORM

• If you are applying yourself, please fill all details and email the application to
leadindia@timesgroup.com.
• If you are nominaing someone, provide as much information as possible – name and
contact details necessary, at the very least.
• By filling in your name at the bottom, you agree to abide by the Terms and Conditions
of Lead India.

Name : __APURBA KUMAR

RAY_____________________________

Date of Birth (DD/MM/YY) : _12-03-

1979______________________________

Gender : __Male_____________________________

Highest Educational Qualification :B.Sc, Diploma in Civil Engg., MCA

(Studing)_______________________

Occupation (Self-Employed/Salaried/Others) :
_____Salaried___________________

If self employed, describe nature of business : _____________________

_____________________________________________________________

How many people do you employ? (0/1 - 10/11 - 100/100+):___________

If salaried, designation:______Technical Assistant____

_______________________________
Company: ________Calcutta
University____________________________________________

If others, provide details _________________________________________

Languages known:,
Language 1: ____ Bengali
Degree of Proficiency (Read/Write/Speak): ____( Read/Write/Speak )_________
____________________________

Language 2: ___ English ___ ___________

Degree of Proficiency (Read/Write/Speak): _____(Read/Write/Speak
_)___________________________

Language 3: _____ Hindi _

_____________
Degree of Proficiency (Read/Write/Speak): __(Read/
Speak)______________________________

Postal Address: _ 5/21, CHITTARANJAN

COLONY___________________________________________
______ _ _P.O.-JADAVPUR
UNIVERSITY_____________________________________________________
______________KOLKATA-
700032______________________________________________________

Email Address:
______apurbakumar@gmail.com_____________________________________________
___

Phone No.: __1>_9231906289__2>033-

24257936_______________________________________________

Which city are you applying from? (Please choose one of: Ahmedabad, Bangalore, Delhi,
Hyderabad, Kolkata, Lucknow, Mumbai,
Pune):__Kolkata___________________________

Have you ever held a position of leadership in your school/college/locality?

If so, give details
_________Class Captain in
Schools____________________________________________________________
_________Cricket Captain in
School____________________________________________________________
_________Organizing Tour/Picnic _in College_and in
Office__________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________

*By filling out this form I agree to abide by the terms and conditions of the Lead India
programme.
(For details of terms and conditions, log on to www.lead.timesofindia.com)

(NAME) APURBA KUMAR RAY