Technician Registration

Personal Data

Full Name: *
Father Name: *
Mobile No: *
DOB: *
Gender: *
Govt. Authorized ID Number: *
Residential address: *
Working address *
City: *
Zip Code: *
State: *
Country: *
Email ID: *
Password: *

Educational Data

Higher Secondary (10th) : *
Higher Secondary (10th) Board Name: *
Higher Secondary (10th) School / College Name: *
Higher Secondary (10th) Status : *
Percentage % : *
Year of Passing: *
Senior Secondary (12th) :
Senior Secondary (12th) Board Name:
Senior Secondary (12th) School / College Name:
Senior Secondary (12th) Status :
Percentage % :
Year of Passing:

Professional Education Data

Choose your qualification :
Degree & Above
Diploma
Others
Diploma :
Exact Name of Course Certification:
Institute Name:
Year of Passing:
Duration of Course:
Mode of Course:
Institute Location : Country :
Bachelor Degree :
Exact Name of Course Certification:
Institute Name:
Year of Passing:
Duration of Course:
Mode of Course:
Institute Location : Country :
Master degrees :
Exact Name of Course Certification:
Institute Name: *
Year of Passing:
Duration of Course:
Mode of Course:
Institute Location : Country :
Ph.D. :
Exact Name of Course Certification:
Institute Name:
Year of Passing:
Duration of Course:
Mode of Course:
Institute Location : Country :

Professional Data

Employeement Status :
Name of Employer :
Salary Range(per Annum) :
Designation :
EPF Account Number(Optional):
I hereby give my consent to share my EPF Account Number with
MoHFW with following Terms and Conditions.

The EPF Account Number asked here will be used for
the purpose of verification of identity only and will
not be shared with anybody or used for any other purpose.
If yes please specify nature of job?
(Note: You can select Multiple Option)
Specify Other Practice :
Nature of Institute:
(Note: You can select Multiple Option)
Specify Other :
Practice Location :
Country :
State:
District :
Sub District :
Village/Town/City :
Area/Locality/Sector :
Postal Code :
Upload Certificate: