Surajit

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 : ____________________________

___Mr.Surajit Doley

Date of Birth (DD/MM/YY) : ________17/02/1979_______________________ Gender

:

_________Male______________________

Highest Educational Qualification : __B.Com_______________________ Occupation (Self-Employed/Salaried/Others) Employed__________________

: ______Self

If self employed, describe nature of business : __Service Provider, Manpower and Education Consutancy___________________ _____________________________________________________________ How many people do you employ? (0/1 - 10/11 - 100/100+):__10/11_________ If salaried, designation:__________ _______________________________ Company: ____________________________________________________ If others, provide details _________________________________________

Languages known: Language 1: _____English _____________ Degree of Proficiency (Read/Write/Speak): __Read/Write/Speak______________________________ Language 2: _____Hindi_____________ Degree of Proficiency (Read/Write/Speak): __ Read/Write/Speak ______________________________ Language 3: _____Assamese_____________ Degree of Proficiency (Read/Write/Speak): ___Read/Write/Speak _____________________________ Postal Address: ___House No.-14, Ground Floor, 12th Cross, 20th Main, ___________________________________________________ ________________ Venkateshwara Layout, BTM 1st Stage, ____________________________________________________ _________________Bangalore, Karnataka 560068___________________________________________________ Email Address: [email protected]__________________________________________________ ___ Phone No.: _0-9886065171, 09916083170_____________________________________________________ Which city are you applying from? (Please choose one of: Ahmedabad, Bangalore, Delhi, Hyderabad, Kolkata, Lucknow, Mumbai, Pune):___Bangalore__________________________ Have you ever held a position of leadership in your school/college/locality? If so, give details ___It was on 2001 Pragjyotish College, Guwahati, Assam; I have given nomination for college election for the post of Asst. General Secretary with the support from all the students, teacher and the Office Staff.. There were five persons who Has given nomination for the same post. There was a rule in that College that who belongs to that locality where College Situated they can only gives nomination for election. I was the First person there who breaks that rule. I did campaigning Only with five guys for three days. Nobody wants to take Part with me. And the final day came. That day I was also little Nervous. After pooling one of our lecturer came and told that only me was in contest. After that result comes out.

I have lost by four votes. But I was pretty satisfied. The college principal ask me to go for re-counting, Sir also has had Some doudt.but I denied._____ *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) Surajit Doley (NAME)