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OFFICE OF TI IE DIRECTOR
AVIATION SECURITY TRAINING
INSTITUTE, JAIPUR, RAJASTHAN
CAMP\JS-11 A, NEHRU NAGAR, JAJPUR-302016 (RAJASTHAN)
PHONE No 0141-2301729, 2309464 (Fax)
E-Mail : [email protected]/[email protected]

SR.NO.:- ITA/ASTI/AVSEC.Basic./2024/ ...,.S 1/ ,..12- Date:- 'l..~. Jo. ?-c:l1-1f

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( J) Dully filled nomination fonn with participant signature and signature with
Seal of sponsoring organization.
(2) Organiution ID card copy.
(3) Graduation/Senior Secondary Cerificate photo copy.
(4) AvSec Induction Course Result and Certificate copy.

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fl§P:i :- 1. Nomination Form

Director
ASTI,APSU
ITA,Jaipur
g~~fil:-
1- ADGP, Armed Battalions, Rajasthan, Jaipur.
2- RD, BCAS, Jaipur.

Director
ASTI,APSU
ITA,Jaipur
/

/
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RaJK!il R&f Nr.,.: 11294313

 BUREAU OF CIVIL AVIATION SECURITY
MINISTRY OF CIVIL AVIATION
GOVERNMENT OF INDIA
NEW DELHI

BCAS-TRG-DIV APPENDIX:”U”

Part -I

1. Name of the Candidate:_______________________________________________

Passport size (70%
(Surname) (First name) (Middle name) face white
background Matte
2. Sex : Male Female finish)
3. Designation of Candidate :- ________________________________

4. E-mail ID:_______________________________________________

5. Mobile No.:- ___________________________________________

Signature of
6. Date of Birth ( DD/MM/YY):_____/_____ / _____ Individual
7. Nationality ___________________(Indian)

8. Educational Qualification (Academic)__________________________________

9. Educational Qualification (Technical)__________________________________

PART: II

Details of Previous AVSEC Courses Attended by Nominee*

Sr Course Name PERIOD Marks Remarks

No FROM TO RESULT
obtained

*(Note- Non disclosure of any information pertaining to previous AVSEC Courses will
amount to disqualification of the candidate)
PART: III

Working Experience

S.No Organization Designation Period Remarks

From To
AEP No._____________________

Employee Code.________________

Date:
Signature of the candidate
Place of Posting:
PART:IV

NOMINATION/REGISTRATION FORM

1. Course Name:__________________________________________

2. Exam Centre:________________________________________

3. Duration of Course - From:______________To:_______________

4. Name & contact address ofSponsoring Organization:_________________

__________________________________________________________

5. Name &Contact address of paying organization _______________________________

___________________________________________________________________

Declaration by Sponsoring Organization

I ________________certify that the above mentioned nominee is medically fit and fluent in
spoken& writing English. He / She is on regular pay roll of this organization as security
employee and falls within the parameters of the course target population as defined in NCASTP.
The security program of my organization is approved by Competent Authority and the
information disclosed under this form is correct as per best of my knowledge.

1. Name of sponsoring authority:

2. Designation :

Date: Signature with seal

PART: V

(For BCAS use only)

The nomination of Ms/Mr:_____________________________is accepted/not accepted

Date: Signature of BCAS Official