Form

Personal Information (SECC)

M

F

T

State

Name

Sex

District

Date of Birth

Tehsil

Village

Father’s Name

Mother’s Name

Address

Personal Mobile No.

AHL-TIN

Parent’s Mobile No.

Category (SC/ST/Other)

Email-address

Address (Permanent and Present)

State

State

District

Block

District

Block

Gram Panchayat

Gram Panchayat

Village

Village

Permanent Address

Present Address

Personal Information

Head of Household’s Highest Education Qualification

Yearly Income of the Family (Rs)

PWD (Yes/No)

Minority (Yes/No)

NREGA Job Card No

Total Days worked in NREGA last year

Whether any member of Household belong to SHG (Y/N)

Do you have Antyodaya Card?

Do you have Driving License?

BPL Card No?

Do you have RSBY Card?

Marital Status (Married/Unmarried)

Your Highest Education Qualification in School

Last Year of Passing in School

Technical Education (Btech/BEd/BSc/Diploma/Other)

Last Year of Passing (Technical Education)

Are you currently employed? (Y/N)

What is the nature of employment? (Self Employment / Wage Employment)

Domain of Technical Education

What is personal current monthly earning in Rupees?

Are you interested in Wage Employment, Self-Employment, Both or None?

Are you interested in Direct Job, Training, Both or None?

Are you willing to move to a different District for a Job?

Are you willing to move to a different State for a Job?

Have you received any training before – DDUGKY, PMKVY, ITI, Other or None)

Expected Minimum Monthly Salary?

Sector Information

Which Sector are you interested in?

Sector 1

Trade 1

Sector 2

Trade 2

Sector 3

Trade 3

Had you heard about DDUGKY before?

Where had you heard about DDUGKY before?

Signature of Mobilizer

Signature of Candidate