[AI] Database form

pamnani pamnani at vsnl.com
Sun Jun 22 09:30:34 EDT 2008


XRCVC EMPLOYMENT DATABASE QUESTIONNAIRE (ADVANCED)

(Please return to pamnani.kanchan1 at gmail.com
  

Personal

 

Name:  

 

Year of Birth: 

 

Sex:             

 

Type of Visual Impairment (Total/ Partial/ None):

 

Nature of Visual Impairment (From Birth/ Late; if late, in what year):

 

Cause of Visual Impairment:

 

 

Contact Details

 

Address (Complete with the Pin code):  

 

Residence:

 

Office:

 

Telephone

 

Res.: 

Mobile: 

Off.:  



Email:  

 

 

Professional

 

Qualification (with specialization): 

 

College/ Institute:

 

Year of Graduation: 

 

Profession:

 

Professional History (list of past work assignments):

 

Current Employer:   

 

 

Current Designation:

 

Nature of employment (Self- employed/ private/ government): 

 

Income (optional):

 

Fringe Benefits (optional):

 

Remarks

(Please enter your opinions of the advantages and disadvantages of your workplace)

 

Pros:

 

 

 

 

Cons:

 

 

 

 

Instances of specific modifications made for effective integration into work environment and processes (additions or changes):

 

 

 

 

Thank you for your valuable contribution!

 

 

 



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