Lead India Application Form

APPLICATION FORM • If you are applying yourself, please fill all details and email the application to [email protected]. • If you are nominaing someone, provide as much information as possible – name and contact details necessary, at the very least. • By filling in your name at the bottom, you agree to abide by the Terms and Conditions of Lead India. Name

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Date of Birth (DD/MM/YY) :

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Gender

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Highest Educational Qualification

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Occupation (Self-Employed/Salaried/Others)

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If self employed, describe nature of business : _____________________ _____________________________________________________________ How many people do you employ? (0/1 - 10/11 - 100/100+):___________ If salaried, designation:__________ _______________________________ Company: ____________________________________________________ If others, provide details _________________________________________ Languages known: Language 1: __________________ Degree of Proficiency (Read/Write/Speak): ________________________________

Language 2: __________________ Degree of Proficiency (Read/Write/Speak): ________________________________ Language 3: __________________ Degree of Proficiency (Read/Write/Speak): ________________________________ Postal Address: ______________________________________________________ ____________________________________________________________________ ____________________________________________________________________ Email Address:

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Phone No.:

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Which city are you applying from? (Please choose one of: Ahmedabad, Bangalore, Delhi, Hyderabad, Kolkata, Lucknow, Mumbai, Pune):_____________________________ Have you ever held a position of leadership in your school/college/locality? If so, give details _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ *By filling out this form I agree to abide by the terms and conditions of the Lead India programme. (For details of terms and conditions, log on to www.lead.timesofindia.com)

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