Application form for Internship in NHAI

Kindly fill all the fields. Fields marked with * are mandatory.


College Details
Name of the College :
Affiliated to University:
Name of the designated Authority:
Designation:
Contact Details: Email*: Mobile No.: Phone No.:
Address: Address: City: *State
PinCode:
Whether the candidate obtainted overall 70% marks or equivalent grade in all the previous yearly/semester examinations and no backlogs (reappears) of any subjects?
Whether the UGC/AICTE/Government approved Universities/Institutions/Colleges?
Student Details
Name of the Student: *Salutation
 
*FirstName Middle Name: Last Name:
Date of Birth*:

Gender*:

Father's/Mother's Name : *Salutation
 
First Name*: Middle Name: Last Name:
Address: Address: City: State:
 
PinCode:
Contact Details: Email*: Mobile Number: Phone Number:
Category: Religion:
Nationality:
Whether belonging to Minority Community, If Yes, Please Specify
Whether belonging to Physically Disabled, If Yes, Please Specify
Name of the Branch / Discipline: Present Semester:
College/University Enrollment/Roll/Id No.:  
Whether undergone Internship earlier with NHAI:
Proposed Place of Internship: Option-1 Option-2
Option-3
Expected Duration of Internship (In Months):

Declaration


I hereby declare that all the information furnished above is true and correct to the best of my knowledge and belief. I undertake that, if at any stage of the selection or even after selection, any of the information furnished is found to be false, incorrect or misleading, the candidature/ appointment/ service will stand cancelled / terminated without assigning any reason.