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APPLICATION FORM

• If you are applying yourself, please fill all details and email the application to
leadindia@timesgroup.com.
• 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) : ______Self


Employed__________________

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:
_surajit.doley@gmail.com__________________________________________________
___

Phone No.: _0-9886065171, 0-


9916083170_____________________________________________________

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)