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{% extends "easy_pdf/base.html" %}
{% load staticfiles %}
<!DOCTYPE html PUBLIC "-//W3C//DTD HTML 4.01 Transitional//EN" "http://www.w3.org/TR/html4/loose.dtd">
{% block content %}
<html>
<head>

<meta http-equiv="Content-Type" content="text/html; charset=ISO-8859-1">
<title>BITS</title>
</head>
<style>
#rectangle1{border:1px solid black; }
#rectangle1 h5{border:none;}
#title{
text-align:center;
top:50px;
}

#form_name{
text-align:center;
}
  body{
      font-size: 10px;
      font-family: Calibri;
    }

/*table, th, td {
    border: 1px solid blue;
    border-collapse: collapse;
}
*/
th{
padding:10px;
}

.footer span {
width:3cm;
border-bottom:0.1em solid #000;
display:inline-block;
}

.main span{
width:3cm;
border-bottom:0.1em solid #000;
display:inline-block;

}
img{zoom:80%;}

    @page {
                size: A4;
                margin: 1cm;
                @frame footer {
                    -pdf-frame-content: footerContent;
                    bottom: 0cm;
                    margin-left: 15cm;
                    margin-right: 9cm;
                    height: 1cm;
                }

            

            
    
        size: a4 portrait;
        @frame header_frame {           /* Static Frame */
            -pdf-frame-content: header_content;
            left: 490pt; width: 512pt; top: 20pt; height: 40pt;
        
        
    }

       
</style>
<body>
 <div id="header_content" style="font-size: 14px;"><b>MTSS {{q.0.id}}</b></div>

<h3 id="title" style="font-size: 12px;"><b>Birla Institue of Technology & Science,Pilani,Rajasthan<br>Work Integrated Learning Programmes Division</b></h3>

<h4 id="form_name" style="font-size: 11px;"><b>Application for Admission to {{q.0.program.program_name}} for First Semester 2015-16</b></h4>

<div id="rectangle1" style=" ">
<label style="margin-top: 8px;margin-left: 4px;" style="font-size: 10px;"><b>&nbsp&nbsp&nbspFor Office use only</b></label><br/>
<label style="margin-left: 4px;border-bottom: 1px solid black;" style="font-size: 10px;">&nbsp&nbsp&nbspID No.:_________{{q.0.program.program_code}}______&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp</label>
<label style="margin-left: 650px;">&nbsp&nbsp&nbspDate of Receipt:_________________<span></span></label><br/>
<label style="margin-left: 4px;">&nbsp&nbsp&nbspRemarks,if any:________________________________________</label><br/>
<label>&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbspDean</label>&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp
<label style="float:right">Vice-Chancellor</label><br/>
</div>
<br>
<br>
<br><br><br><br>


<h4><b>SECTION 1:PERSONAL INFORMATION & EDUCATIONAL BACKGROUND</b></h4>


<table style="width:100%">
  <tr>

    <td style="font-size: 12px;">1.Name: {{sca.full_name}}</td>
    <td rowspan="9" colspan="0" style="width: 144px; height:120px;" >&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp
        <img src="{{ photo.url }}" style="margin-left:-145px;"></td></tr>

   
  
  <tr>
      <td style="font-size: 12px;">2.Gender: {{sca.get_gender_display}}</td>
  </tr>
  <tr>
    <td style="font-size: 12px;">3.Date of Birth: {{sca.date_of_birth}}</td>
  </tr>
  <tr>
    <td style="font-size: 12px;">4.Father's Name: {{sca.fathers_name}}</td>
  </tr>
  <tr>
    <td style="font-size: 12px;">5.Mother's Name: {{sca.mothers_name}}</td>
  </tr>
  <tr>
    <td style="font-size: 12px;">6.Email: {{sca.email_id}}</td>
  </tr>
  <tr>
    <td style="font-size: 12px;">7.Mobile/Phone: {{sca.mobile}}/{{sca.phone}}</td>
  </tr>
  <tr>
    <td style="font-size: 12px;">8.Nationality:{{sca.get_nationality_display}}</td>
  </tr>
  <tr>
    <td style="font-size: 12px;">9.Do you belong to Scheduled Caste or Scheduled Tribe?[Y/N]_________</td>
  </tr>
  <tr>
    <td style="font-size: 12px;">10.Address for Correspondence:{{sca.address_line_1}}</br>
&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp{{sca.address_line_2}}</br>
&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp{{sca.address_line_3}}</br>
&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp{{sca.city}},{{sca.get_state_display}},{{sca.get_country_display}}</br>
</td>
  </tr>
</table>

</br>
<table style="width:100%; border: 1px solid black;">
<p><b>11.Educational details</b></p>
<tr>
<th style="font-size: 12px;" >Name of Diploma/Degree</th>
<th style="font-size: 12px;">Subject/Branch</th>
<th>Year of completion</th>
<th>Total Marks Obtained</th>
<th>Maximum Marks</th>
<th>Final % Marks *</th>
</tr>


{%for element1 in scq%}
<tr>
<td style="padding:5px">{{element1.degree.degree_short_name}}</td>
<td style="padding:5px">{{element1.discipline.discipline_name}}</td>
<td style="padding:5px">{{element1.completion_year}}</td>
<td style="padding:5px">{{element1.percentage_marks_cgpa}}</td>
<td style="padding:5px">---</td>
<td style="padding:5px">---</td>
</tr>

{% endfor %}
</table>
<h5><i>*As Calculated for declaring result and award Of Division by your Board / university.If marks are not awarded,give Cumulative Grade Point Average 

Or its equivalent.Explain below the basis on which your B. SC. / B.E. M. SC. / M. C.A. (Or equivalent)final percentage is Calculated (Cleary explain 

gaps, if any in a separate Sheet.) 
</i></h5>
<br>
<hr>
<br>
<p><h5>12.Level at which you have studied Mathematics: {{sca.get_math_proficiency_level_display}}</h5></p>
<p><h5>13.Are you currently enrolled for degree or diploma in any University/Institution:(Y/N) 
  {% if sca.parallel_studies_flag == 1 %}
  Y
  {% else %} 
 N
  {% endif %}
  <span></span></h5></p>

<p>If Yes,give details specifying the University Institution name,programme name,duration,date of joining the programme and likely date of completion of the same.<hr></p>
<p>14.Have you ever been a student of BITS,Pilani.(Yes/No):if yes,please write name of the degree and your ID No.:{{sca.bits_student_id}}</p>
<hr>
<p><strong>15.Exam Centre Choice:</strong>{{sca.current_location}}<p>The evaluation methodology demands the admitted students to come to an Off-Campus centre at <b>Banglore/Chennai/Delhi/Goa/Hydrabad/Mumbai/Pilani/Pune</b> twice during evry semester of study for duration normally during the weekends and at their own expense for taking the Mid-Semester and Comprehensive examinations.Out of theses centres,indicate your choice of Examination Centre.<h1 style="text-decoration: underline;">{{q.0.exam_location.location_name}}</h1></p>
</br>
 
<small><i>Note:In case exam centre is not indicated the institute will unilaterally assign a Centre.The Institue is also free to demand that syudents come to an Exam Centre other than the one indicated above.Further,in case of Dubai centre there will be an additional exam centre fees,which will be indicated at the time of admission.</i></small>
<p>16.Current Employment Status:{{sca.get_current_employment_status_display}}</p>
<p>17.Total Work Experience:<strong>Years and Months:{{q.0.total_work_experience_in_months}}</strong></p>
<p>18.Work Experience in Current Organisation:<strong>Years & Months & days:
  <
  </strong></p>
<p><small><i>(as on applicable deadline to be counted only fron the point of completing BE/MSc or equivalent))</i></small></</p>
<p><strong>Employment Details:</strong><small>Since the year of completing BE/MSc or equivalent,give brief employment details below in reverse chronological order.</small></p>

<table style="width:100%; border: 1px solid black;">
<tr>
<th>Name of Organization</th>
<th>Designation held</th>
<th>Start Date</th>
<th>End Date</th>

</tr>

<tr>
<td height="200"></td>
<td height="200"></td>
<td height="200"></td>
<td height="200"></td>

</tr>
{% for element1 in scwe %}

<tr>
<td style="padding:5px" >{{element1.organization}}</td>
<td style="padding:5px">{{element1.designations}}</td>
<td style="padding:5px">{{ element1.start_date | date:" D d M Y"}}</td>
<td style="padding:5px">{{ element1.end_date | date:" D d M Y"}}</td>

</tr>

{% endfor %}
<tr>
<th colspan="2">Total Work Experience calculated after completing BE/MSc or equivalent</th>

</tr>

</table>
<br>
<small><i>Provide the dates of start end of the employment period.Clearly explain gaps,if any in a separate sheet.</i></small>

<p><strong>20.Declaration by the Applicant</strong></p>
<p>I have carefully read the details and the instructions given in this form and hereby declare that all the information given and statements 

made in various sections and parts Of this Application Form and enclosures are true to the best of my knowledge. I agree to the condition that if 

information or statement were found to be wrong, my admission to BITS would automaticaly be cancelled. I understand that the objective of the Institute will be

to examine in detail my educational and professional background along with my employer's visualization of my current and future professional involvement 

to accommodate my Career aspirations within the framework Of an appropriate learning avenue. I thus realize that in this process Of matChng, the Institute 

instead Of rejecting my application for admission may even Suggest that I would be more suitable for another degree programme / area Of study for Which I 

have not applied. If admitted,I promise to abide by the Rules and Regulations in force or those that may hereafter be made by the Institute and I shall do 

nothing either inside or outside the Institute which will interfere with its orderly working and discipline.I promise to be regular in the study schedule and in 

appearing in the examinations at allotted centre. If I am required to Pilani for any examination,I shall take permission from my employer for appearing 

in the same. In the case that I myself will be paying my fees / dues,I affirm that I will regularly pay fees/dues to the Institute during my programme.

Further, in all matters concerning the Institute and myself the decision of BITS Vice-Chancellor shall be binding on me. 

</p>


    Place:________________________<span></span>&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp
    Signature: <img src="{{ sign.url }}" style="width:144px; height:55px;"><span></span>
<br>
 Date:________________________<span></span>&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp
 &nbspName:<span></span>



 
 </table> 



<br>

<p>________________________________________________________________________________________________________________________________________________________</p>
<h><b>For Office Use Only:<b><h>
<p><small>Enclosure Verification: Signature________________________________________________Date____________________________________</small></p>
<div id="footerContent">
            {%block page_foot%}
                Page <pdf:pagenumber>
            {%endblock%}
        </div>
</body></html>
{% endblock %}
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