advanced diploma in industrial safety (2011-2012) - DGFASLI

The experience should be in any one of thefollowing:i) Manufacturing, Maintenance or SafetyDepartment in an Industry; ORii) Building or other Construction Works ordepartment of Port or Dock or ConstructionIndustry ORiii) Training or Education, or Research in the fieldof accident prevention in Industry or in anyInstitution. ORiv) Government department in the administrationof any Industrial Safety & Health LegislationsNOTE: Sponsored candidates will be givenpreference.6. APPLICATIONPrescribed application form(s) along with thecourse prospectus may be obtained by downloading from DGFASLI website www.dgfasli.nic.inThe filled in application form(s) along with attestedcopies of certificates and mark-sheets shouldreach the Director (Safety) & in-Charge, SafetyDivision, Central Labour Institute, Sion, Mumbai –400 022 on or before the last date. Envelopecontaining the application form should be super -scribed “APPLICATION FOR ADVANCED DIPLOMAIN INDUSTRIAL SAFETY”. The last date of receiptof filled in application form at Central LabourInstitute is 25 th May, 2011. Applications sent byfax or e-mail will not be entertained.7. SELECTIONThe candidates working in the States/UTs ofMaharashtra, Gujarat, Goa, Dadra & Nagar Haveliand Daman, Diu are eligible for admission to thecourse at the Central Labour Institute, Mumbai.Applications received from candidates of otherstates will be summarily rejected without anyfurther correspondence.After preliminary screening of the applications,candidates will be short-listed and called forinterview before a Selection Committee in Mumbaiin the month of June, 2011.Calling for interview does not guarantee theselection. The decision of the SelectionCommittee shall be final and no correspondencewill be entertained by the Institute, in this regard.No traveling allowance will be paid by the Institutefor attending the interview.Reservation :Reservation of Seats as per Government rules .8. EXAMINATIONThe examination is conducted by the MaharashtraState Board of Technical Education, Mumbai. Thesuccessful candidates are awarded the Diplomaby the Board.9. CHARGESi) Fees : Institute fees (Tuition Fee) @Rs.6000/- (Rupees six thousand only) perstudent for the entire course is to be paid by aseparate crossed demand draft drawn infavour of “Central Labour Institute, Mumbai”at the time of taking admission. The fee oncepaid is neither refundable nor transferable.ii)Library Caution Money : RefundableDeposit of Rs.1000/- (Rupees one thousandonly). This amount should be paid in cash atthe time of taking admission.iii) Hostel Rent : Rs.20/- (Rupees twentyonly) per head per day to be paid in cash for aperiod of one teaching term in advance.iv) Enrolment & Examination Fee : Tobe paid by the candidates to MaharashtraState Board of Technical Examinations, asand when required by the Board.v) Other Expenses : Study Tour/FactoryVisits / Project Work/ all other expenses to beborne by the candidate. This will be managedby student themselves.vi) All students will have to abide a uniform dresscode prescribed by the Institute and expensestowards will be borne by the students /Sponsoring organizations.10. ACCOMMODATIONLimited non-family accommodation on sharingbasis will be allotted only to the outstationcandidates in the CLI Hostel subject to availabilityon first-come-first-served basis as per the date ofreceipt of application.No hostel for women.11. COMMENCEMENTThe course at CLI, Mumbai will commence w.e.f.July, 2011.IMPORTANT NOTICEStatus of application, Interview dates, Listof Selected candidates, Instructions toSelected Candidates, Date ofcommencement of classes. etc. will begiven through our websitewww.dgfasli.nic.in / e-mail.Applicants are advised to see their e-mailand visit our website regularly.***********

CENTRAL LABOUR INSTITUTE(DIRECTORATE GENERAL FACTORY ADVICE SERVICE AND LABOUR INSTITUTES)GOVERNMENT OF INDIA, MINISTRY OF LABOUR AND EMPLOYMENTN.S. MANKIKER MARG, SION, MUMBAI – 400 022Tel: (022) 2409 2203 Website : www.dgfasli.nic.inApplication for admission to ADVANCED DIPLOMA IN INDUSTRIAL SAFETY 2011-2012INSTRUCTIONS TO CANDIDATES Please furnish all information in full. Attach separate sheets wherever the space in the form is inadequate. Attach attested copies of testimonials in respect of age, qualification, experience, caste, etc. includingmark-sheet for qualifying examinations. Admission will not be granted based on provisional certificateissued by colleges. Last date for receipt of application : 25-05-2011. Eligibility Certificate has to be produced by the candidate who have obtainedRecently takenthe required essential qualification from Other than Maharashtra State.PassportThis Certificate should be from Maharashtra State Board Of TechnicalSize PhotoEducation, Mumbai. Incomplete application will summarily be rejected.1 Full Name(in BLOCK LETTERS)2 Father’s Name(As entered in the SSC Certificate)3 Date of Birth4 Permanent Address(Date) ___________ (Month) _____________ (Year) ______________…………………………………………………………………………….…………………………………………………………………………….5 Present Address/Address forCommunicationPin Code: Tel: Fax:…………………………………………………………………………….……………………………………………………………………………State: ………………………………………..Pin code …………………Tel: Fax: Mob No :6 Active E-mail ID of thecandidate7 Are you a member ofSC / ST / OBC / VJ /NT Yes / No(Indicate category) _______________________________________# Please attach attested copies of certificates issued by Competent Authority# Candidate belong to NT1, NT2, OBC should attach Non-Creamy- Layercertificate for the financial year starting from April 2010

28. Details of Academic Qualifications (S.S.C. onward in chronological order )YearExaminationPassedName and Addressof Board/UniversitySubjectMarksobtained /out ofPercentageClass/DivisionNo. ofAttempts1 2 3 4 5 6 7 89. (a) Details of Experience (in chronological Order):Name and Address of Periodthe Organisation From ToDuration Designation Nature of Duties(Attach certificate from Employer)--------yearsþ-----months-------days------years-----months------days-------years------months------days---------years------months------days(Please attach attested copies of experience certificates clearly indicating the experience specifically in manufacture,maintenance and safety department. Experience in laboratory, R&D, Quality, competent person, part-time job, selfemployment, etc. are not considered. Certificates/documents like joining letter, relieving order, promotion order,acceptance of resignation, etc. will not be considered for the purpose of counting the duration of employment)9. (b) Total Experience (As on 01-05-2011) : Years____________ Months _________Days_______(c) Total Experience in Supervisory Capacity : Years ____________Months_________Days_______(As on 01-05-2011)

10. Details of the Papers published, if any:311. Extra curricular activities, if any:12. Any other information the applicant desires to give in support of the application:13. Hostel accommodation : Required / Not Required(No hostel for women)14. Are you Sponsored? {If yes, please provide the : Yes / Nocertificate given on page No.4 (Annex-A) on Company’s Letter Head.15. In case of emergency, etc. name, address, other :details of the parent/guardian to be contactedincluding telephone no., mobile No.,fax No., email id, etc.DECLARATION BY THE CANDIDATEI hereby declare that information furnished in the application is true and correct to the best of my knowledge and beliefand that no material information has been willfully suppressed by me. If at any stage it is found that I do not fulfill theeligibility requirements, have used fraudulent means to secure admission, have made false or incorrect statements or myqualifying examination is not recognised by the Maharashtra State Board of Technical Education, Mumbai, then I shallnot be allowed to appear at the interview, complete admission formalities, or if at all admitted, my admission shall becancelled and my application/certificates/documents and the fee paid shall not be returned. I also undertake that aftermy admission to the course, I shall complete the requisite attendance, projects and term work within the specified periodof the course.Place:Date :----------------------------------------------------(Signature of the Candidate)

4ANNEX- 'A'CERTIFICATE BY SPONSORING AUTHORITY(To be submitted on the Company’s Letter Head)1. We hereby sponsor Shri _________________________________________ for the AdvancedDiploma in Industrial Safety Course-2011-12. He/She possesses ________ years _______ months ofexperience in Supervisory Grade/Capacity as certified below.Sr.No.Post / DesignationLength of full-time Experience inManufacturing Maintenance Safety_____ years _____ years _____ years_____ months _____ months _____ months_____ years _____ years _____ years_____ months _____ months _____ months_____ years _____ years _____ years_____ months _____ months _____ months_____ years _____ years _____ years_____ months _____ months _____ months_____ years _____ years _____ years_____ months _____ months _____ months2. Shri ______________________________________ joined this organization on ________________as ___________________________________________ and at present he is working as_______________________________________________ from ____________ to _____________ .3. On his selection, he will be fully relieved to attend classes, do the project work in our industry andalso appear in the examination. He will not be engaged in any normal duties until the completion ofthe course.4. If the sponsorship is withdrawn by the management during the course, the candidate will bedisqualified from continuance of the course.5. His present place of posting is ………………………………………………………..Place :_____________________________________Date : Office Stamp Signature of Sponsoring AuthorityName :Office Tel No with STD code, Fax no and E Mail id must be givenDesignation :

5(FOR OFFICE USE ONLY)APPLICATION NO.: Date: / / 20111 Sponsored / Permitted Yes No2 Certificate of sponsorship/permission attached? Yes No3 a) Government (Central/State) Yes Nob) Government of India Undertaking Yes Noc) Others Yes No4 Basic Qualification (BE/Dip. In Engg./ B.Sc.)5 Application Rejected Yes NoReason : Incomplete / Not Qualified / Less Experience6 Called for interview : Date: (FN / AN)7 Selected Yes No8 Hostel Accommodation given Yes No9. Selection Committee Remarks: Date:------------------ -------------------- -------------------- ------------------- --------------------- -----------------Member Member Member Member Member Chairman

Check List for valid Application(Please ensure the following before sending your application form)1. Whether you have written your name in the application form in the same manner as isshown in your High School Certificate?2. Since only those who possess requisite qualification and experience are eligible to apply,please check whether you fulfill the eligibility criteria. In case you are employed,sponsorship / no objection certificate from the present employer duly signed along withhis legible seal and full address should be attached.3. Whether you have enclosed copies of your high school certificate and degree / diplomacertificates along with their mark sheets as well as experience certificates (showing theduration and nature of the experience), duly attested by a gazetted officer?4. Whether original certificates of high school/ degree / diploma are in your safe custody?These will have to be produced before admission. Admission will not be given basedupon the provisional certificates.5. Whether you have enclosed equivalence certificate for the basic minimum qualificationrequired for the course? (This is necessary only for those candidates who claim that theexamination passed by them is equivalent to the basic minimum qualification.)6. Whether you have signed in your application form?******