Online Application form for various posts under CAPE Please go through the Instructions before filling up this form Post applied for Professor Associate Professor Assistant Professor Senior Residents Junior Residents/Tutors Name of Candidate (Initials must be at the end)* Date of Birth* Day   1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31    Month  Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec    Year  1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000   Age* Use <Tab> key to navigate instead of <Enter> key through the fields. Religion Nationality Caste/Community Sex*   Male Female Address for communication   House Name/No. * Place* City/District, Post Office* Pin Code*   Permanent address (Same as above    )   House Name/No. *   Place*   City/District, Post Office*   Pin Code*   E-mail id   Contact number     STD Code Telephone* Mobile   Whether belong to SC/ST (Specify Yes or No) No Yes   Details of qualifying examination     Degree*:   Subject /Branch   University : Month & Year of Passing Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009   General Academic Profile from S.S.L.C and after Examination passed Specialisation/Major subject Institution/College University/Board Percentage S.S.L.C Plus 2 / P.D.C Degree Post Graduation Any other Details of work experience (if any) Organisation Designation/Nature of Job Duration(Years /months)       Details of payment of Registration fee DD. No. * DD. Date* Day   1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31    Month  Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec    Year  2009 Name of Bank * Payable at *   Declaration I do hereby affirm that all the particulars furnished above are true to the best of my knowledge and belief and that I agree to bind myself to the conditions of service of the Co-operative Academy of Professional Education, CAPE that may be drawn up from time to time. I agree*