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 : _______________________________

Date of Birth (DD/MM/YY) : _______________________________

Gender : _______________________________

Highest Educational Qualification : _________________________

Occupation (Self-Employed/Salaried/Others) : ________________________

If self employed, describe nature of business : _____________________

_____________________________________________________________

How many people do you employ? (0/1 - 10/11 - 100/100+):___________

If salaried, designation:__________ _______________________________

Company: ____________________________________________________

If others, provide details _________________________________________

Languages known:

Language 1: __________________
Degree of Proficiency (Read/Write/Speak): ________________________________
Language 2: __________________
Degree of Proficiency (Read/Write/Speak): ________________________________

Language 3: __________________
Degree of Proficiency (Read/Write/Speak): ________________________________

Postal Address: ______________________________________________________

____________________________________________________________________
____________________________________________________________________

Email Address: ______________________________________________________

Phone No.: ______________________________________________________

Which city are you applying from? (Please choose one of: Ahmedabad, Bangalore, Delhi,
Hyderabad, Kolkata, Lucknow, Mumbai, Pune):_____________________________

Have you ever held a position of leadership in your school/college/locality?

If so, give details
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________

*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)

(NAME)