Ali Yavar Jung National Institute of Speech & Hearing Disabilities
(ISO 9001:2015 Certified Organization, Under the Department of Empowerment of Persons
with Disabilities (Divyangjan), MSJ&E, Govt. of India)
Candidate Registration Form
Case File Number of AYJNISHD (if available)
Name
*
Father's / Guardian's Name
*
Date of Birth
*
Gender
*
Select Gender
Male
Female
Transgender
Marital Status
*
Select Marital Status
Unmarried
Widow
Widower
Separated
Married
Religion
Select Religion
Hindu
Christian
Muslim
Sikh
Other
Punjabi
Category
Select Category
ST
SC
OBC
General
Address for Communication
Mobile Number of Jobseeker
*
Mobile Number of Family Member
*
Email Id
*
Aadhar Number
*
State
*
Select State
Andaman and Nicobar Islands
Andhra Pradesh
Arunachal Pradesh
Assam
Bihar
Chandigarh
Chhattisgarh
Dadra and Nagar Haveli
Daman and Diu
Delhi
Goa
Gujarat
Haryana
Himachal Pradesh
Jammu and Kashmir
Jharkhand
Karnataka
Kerala
Lakshadweep
Madhya Pradesh
Maharashtra
Manipur
Meghalaya
Mizoram
Nagaland
Odisha
Puducherry
Punjab
Rajasthan
Sikkim
Tamil Nadu
Telangana
Tripura
Uttarakhand
Uttar Pradesh
West Bengal
District
*
Select District
Pincode
*
Address
*
Monthly Family Total Income: ( in Rs. )
Educational Qualification
Highest Qualification
*
Select Qualification
MA
M.com
Msc
MBA
BA
B.com
Bsc
BBA
B.tech
BE
SSC
Below SSC
Diploma
ITI
HSC
Illiterate
Other
Other Qualification
*
Client Technical Eduation
Select Technical Eduation
Diploma
Certificate Courses ms-cit
DTP
Other
Other Technical Eduation
*
Mode of Communication
*
Select Communication
Sign language
Verbal Communication
Gesture
Total Communication
Type of Disability
*
Select Disability
Hearing Disability
Speech & Hearing Disability
Degree of disability in %
*
Upload Scanned Copy of Disability Certificate
*
Upload
File Formats: jpeg, png, jpg, pdf
File Size: 5MB
Total Work Experience (if any ) in Months/Year
Experience Details
Post
Name of the Company
Salary Drawn per month
Work Details
Add More Experience Details
Upload Photo
Upload
File Formats: jpeg, png, jpg
File Size: 20KB
Upload Signature
Upload
File Formats: jpeg, png, jpg
File Size: 20KB
Upload Resume
Upload
File Formats: pdf, doc, docx
File Size: 2MB
Self Declaration
*
I hereby declare that the information given in this Registration form is true and correct to the best of my knowledge and belief. In case any information given in this registration form/subsequent updation of the Resume proves to be false or incorrect, I shall be responsible for the consequences.
Register
