JMET Registration No:

Application No.

(For Office Use Only)

Indian Institute of Technology Kharagpur

Department of Humanities and Social Sciences

Master of Human Resource Management (MHRM)

(2011 2013 Batch)

JMET Rank: Preferred location for GD / PI (please tick only one): Kharagpur Delhi* Bangalore* Mumbai*

* Tentative locations subject to number of applicants and availability of resources. Graduates attach attested copies of degree certificate and final year mark list. Final year students please attach attested copies of all semester mark sheets. The Application Form should be duly filled in, signed and sent along with a DD of Rs. 1,000/- (Rs. 500/- for SC/ST/OBC/PH candidates) drawn in favour of IIT Kharagpur" payable at Kharagpur to: The Assistant Registrar (PGS&R) Indian Institute of Technology Kharagpur Kharagpur 721302 (West Bengal) Last date of receiving duly filled application February 21, 2011 If you have any other questions, please send them to: The Admissions Coordinator MHRM Programme, Department of HSS, Indian Institute of Technology Kharagpur, Kharagpur 721302. Fax: 03222 282270/255303 email: admission.mhrm.iitkgp@gmail.com / vng@hss.iitkgp.ernet.in Post, fax or email messages are preferred by the Department. Only if absolutely necessary, you may telephone at (03222) 283612/282270. For Office Use Only Name: Contact Telephone No: E-mail: Date of Birth: Qualifying Examination (with % of marks): Work/Job Experience (in Months): Blood Group:

Indian Institute of Technology Kharagpur

Department of Humanities and Social Sciences

Master of Human Resource Management (MHRM)

(2011 2013 Batch) A. Personal Information 1. Name (In Capital Letters): _________________________________ (As per the Certificate of Qualifying Examination) 2. Date of Birth: 3. Gender: M DD F SC MM YYYY 4. Nationality: ___________ ST PH OBC
Place a 2.5 cm 2 cm Stamp size Photo.

5. Category: Gen

(Please attach an attested copy of your SC/ST/PH/OBC(non creamy layer) certificate)

6. Blood Group:_______ 7. Address for Communication: Road/Street/Building/Apartment No. :____________________________ Village/Town/City/District State/Union Territory PIN 8. Permanent Address: Road/Street/Building/Apartment No. :____________________________ Village/Town/City/District State/Union Territory PIN : ____________________________ : ___________________________ : ____________________________ : ___________________________

9. (a) Contact (STD Code)Telephone No.:(___________) _________ (b) Cell No. (if any)__________ 10. E-mail Address 11. Next of Kin:
(Give the name and contact information of your parent, spouse, or other next-of-kin):

: _______________________

12. Fees Details Amount: DD No.: Drawn in favor of: IIT Kharagpur

Amount In words: Rupees Date: Payable at: Kharagpur

B. Educational Background 13. (a) Qualification (From Class X to Graduation Name of University / Board Year of passing Examination

Subjects / Specialization

% of marks

13. (b) Master Degree (if any) Name of University / Board Examination

Year of passing

Subjects / Specialization

% of marks

13. (c) Professional Qualification (if any) Name of University / Board Year of passing Examination

Subjects / Specialization

% of marks

C. Work Experience (Start with the present occupation) Organization From To Total Monthly Experience compensation (Months) (Rs.)

Designa tion

Your duties/tasks in brief

N.B. Attach a separate sheet if required D. Career and Personal Goals Briefly describe what you consider to be your professional and personal goals at the present time, and how you plan to achieve them (Attach a separate sheet. E. Professional Achievement Describe what you consider to be your significant professional achievements so far (Final year projects, internships, etc. can be included) (Attach a separate sheet.

F. Personal Achievement Describe what you consider to be your significant personal achievements so far (Hobbies, extra-curricular activities can be included) (Attach a separate sheet). G. References Name and address of two references

(1) Name: Designation: Organization: Address:

(1) Name: Designation: Organization: Address:

Contact No.: Email:

Contact No.: Email:

H. Declaration I certify that the information furnished by me in this application for admission is true and correct, and understand that my candidature stands cancelled if the information is found not to be so.

Date:______________ Place:______________

_____________________ Signature of the candidate