Use ONE A4 size paper and print this document on both sides

Roll no…………….
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Campus Placement 2018-19

Department of Interest:Choose an item.NCHM no:Click here to enter text.

Mobile no:Click here to enter text.Email:Click here to enter text.

DOB:Click here to enter a date.Skype id:Click here to enter text.

Std X %age:Click here to enter text.Std XII %age:Click here to enter text.

Sem 1 marks:Click here to enter text.out of 1150

Sem 2 marks:Click here to enter text.out of 1050

Sem 3/4 marks:Click here to enter text.out of 1250

Sem 5 marks:Click here to enter text.out of 950

IRT Marks:Click here to enter text.out of 200

IRT Hotel:Click here to enter text.IRT from:Click here to enter a date.toClick here to enter a date.

Job Location preference:Choose an item.

I have read and understood the campus placement policy on

☐I decline the Campus placement facility, as I intend toChoose an item.

☐I accept the Campus Placement facility,and hereby grant IHM-Goa:

  • Permission to submit my Résumé, relevant documents and photograph to Recruiters, electronically, and in printed form.
  • Release of liability, should any untoward incident occur if/when I attend one or more rounds of the selection process that may extend beyond class hours and/or may not be held at the Institute premises, and may involve travel to different parts of the State/ Country.

Signature of Student:Name of StudentClick here to enter text.

Parent’s Name:Click here to enter text.

Signature of Parent::Parent’s Mobile No:Click here to enter text.

  1. Data entered must be genuine and match Institute records/certificates.
  2. Keep this form updated.
  3. This form must be returned to and retained by The Placement coordinator
  4. Loss of this form shall invite disciplinary action

Sr. No / Date / Recruiter / Hotel/Other / Signature of Student / Remarks
(Shortlisted
Selected
Not Selected)