Application for

Dual Degree in Global Suppl y Chain

Management (2015-16 Batch)

Full Name
Gender
Country of Origin
Current Country

:
:
:
:

Application No: IIMU/..

Email
D.O.B.
Age
Citizenship

Contact Details :
Address

City

State

Country

Email

Ph [O]

Ph [R]

Ph [M]

General Details :
GMAT

TOEFL

Code

Code

Date

Date

Verbal

Writing

Quantitative

Speaking

AWA

Listening

Total

Reading
Total

Area of Expertise: (mark in the following manner: 0=no experience, 1=low, 2=moderate, 3=high)
General Management
:
Sales
:
Strategic Management

Production / Operations

Accounting & Control

Service Operations

Finance & Finance Analysis

H.R.M.

Project Management

Information Technology

Marketing
Current Employment :
Employment status
:

Research & Development

Working Since

Managerial

Designation

Functional Area

Company

Industry Type

Web Address

: http://www.

Responsibilities :

No. of people reporting you:

Designation of the person you report to:
Annual Turnover:

Assets Under Your Management:

Annual Gross Salary:

Address

City

Pin Code

State

Country

Phone

Fax

Company Endorsement :
1) Is your organization willing to provide you with financial assistance to meet the cost of the
programme? Yes/No
2) Are they agreeable to provide you with facilities to undertake an in-company project during the
programme? Yes/No
Major Accomplishment:
1)
2)
3)
4)
Total previous experience (Years).:
Employment History:
Duration
Company:

Country:

Designation:

Managerial:

Industry:

No. of people reporting to you:

Function:
Major Accomplishment:
1)
2)
3)
4)

Annual Gross Salary:

Duration
Company:

Country:

Designation:

Managerial:

Industry:

No. of people reporting to you:

Function:
Major Accomplishment:
1)

Annual Gross Salary:

2)
3)
4)
Duration
Company:

Country:

Designation:

Managerial:

Industry:

No. of people reporting to you:

Function:

Annual Gross Salary:

International Exposure:
Duration

Purpose

City

State

Country

Description:

Academic Background:
Duration

Education

Institute

Specialization

Result

Area

Prizes, Awards, Honors or Scholarships:

Prizes received

Awarded by

Year

Area

Year

Area

Year

Area

Accomplishment:

Prizes, Awards, Honors or Scholarships:

Prizes received

Awarded by

Accomplishment:

Prizes, Awards, Honors or Scholarships:

Prizes received

Awarded by

Accomplishment:

Activities /Interests Involved :

Duration

Activity

Organized by

Role Played

Area
City:
State:
Country:
City:
State:
Country:
City:
State:
Country:
City:
State:
Country:
City:
State:
Country:

Self /Career Improvement Efforts:

Duration

Programme Attended

Training Organization

Area
City:
State:
Country:

Benefits Gained:

Duration

Programme Attended

Training Organization

Area
City:
State:
Country:

Benefits Gained:

Duration

Programme Attended

Training Organization

Area
City:
State:
Country:

Benefits Gained:

Duration

Programme Attended

Training Organization

Area
City:
State:
Country:

Benefits Gained:

Duration

Programme Attended

Training Organization

Area
City:
State:
Country:

Benefits Gained:

Language Proficiency:
Mother Tongue/Native Language:
Sr.

Language

Application submitted on:

Reading

/ 2014

Writing

Speaking