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Supervisor Course Application Form

Subhash Tripathi has applied for a specialized course for supervisors working in hazardous industries. He has submitted his application form which provides his personal details like name, father's name, address, date of birth, contact number, email address and qualifications. His qualifications include a Diploma in Engineering from 2010, a B.Sc. in Chemistry and M.Sc. in Chemistry. He has over 4 years of work experience in companies like Gujarat Guardian Limited, Brio Energy Pvt Limited and Uttam Galva Metallics Limited. He has enclosed documents like his degree certificates, experience certificates, proof of birth and a medical certificate with his application.

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Subhash Tripathi
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80 views2 pages

Supervisor Course Application Form

Subhash Tripathi has applied for a specialized course for supervisors working in hazardous industries. He has submitted his application form which provides his personal details like name, father's name, address, date of birth, contact number, email address and qualifications. His qualifications include a Diploma in Engineering from 2010, a B.Sc. in Chemistry and M.Sc. in Chemistry. He has over 4 years of work experience in companies like Gujarat Guardian Limited, Brio Energy Pvt Limited and Uttam Galva Metallics Limited. He has enclosed documents like his degree certificates, experience certificates, proof of birth and a medical certificate with his application.

Uploaded by

Subhash Tripathi
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as DOCX, PDF, TXT or read online on Scribd
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Prosafe Process

Engineering Pvt. Ltd.


719,720 & 722, Western Business Park, Opp. S.D. Jain School, Vesu, Surat.

APPLICATION FORM FOR


SPECIALIZED COURSE FOR SUPERVISORS WORKING IN HAZARDOUS INDUSTRIES
UNDER SECTION 41-C (b) OF FACTORIES ACT, 1948 & Rule 68-S of GFR 1963

NAME OF THE APPLICANT : SUBHASH TRIPATHI


FATHER’S NAME : SHASHI KANT TRIPATHI
ADDRESS : B-23 GUJARAT GUARDIAN TOWNSHIP LIMITED
VALIA ROAD KONDH
ANKLESHWAR GUJARAT 393001
COMPANY NAME : GUJARAT GUARDIAN LIMITED
DATE OF BIRTH : 04/04/1987
CONTACT NO. : 8888591761
E-MAIL ADDRESS : [email protected]
QUALIFICATION :
QUALIFICATION YEAR OF MARKS OBTAINED UNIVERSITY / INSTITUTE
PASSING
DIPLOMA ENGG.
(Chemical, Electrical,
Mechanical or any
branch of
engineering)
DEGREE ENGG. 2010 62.47% RGPV BHOPAL
(Chemical, Electrical,
Mechanical or any
branch of
engineering)
B. Sc. (CHEMISTRY)
M. Sc. (CHEMISTRY)
EXPERIENCE :
NAME OF ORGANIZATION FROM TO TOTAL EXPERIENCE
GUJARAT GUARDIAN LIMITED OCT 2019 PRESENT 4 YEARS
BRIO ENERGY PVT LIMITED JAN 2019 OCT 2019 9 MONTHS
UTTAM GALVA METALLICS LIMITED AUG 2010 JAN 2019 8 YEARS 5 MONTHS

ENCLOSURES: 1) Diploma Engg. / Degree Engg./ B. Sc. (Chemistry) / M. Sc. (Chemistry) Degree Certificate
2) Relevant Experience Certificate (Minimum Experience 5 Years for B. Sc. (Chemistry) & Diploma
Engg., Minimum Experience 2 Years for M. Sc. (Chemistry) or Degree Engg. In process, operation &
maintenance in hazardous process industry).
3) Proof of Birth Date (Leaving Certificate/ S.S.C.E. Certificate)
4) Physical Fitness/ Medical Certificate

APPLICANT SIGNATURE

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