Trainer Application Form

1. PERSONAL DETAILS

Full Name :

Father's / Mother's Name :

Gender :

Male Female Other

Date of Birth :

Mobile Number :

WhatsApp Number :

Email ID :

Aadhar Number :

Current Address :

State :

District :

2. EDUCATIONAL QUALIFICATION

10th Intermediate Degree Post Graduation Diploma

Other:

3. SELF-DEFENCE / MARTIAL ARTS EXPERTISE

Karate Taekwondo Kung Fu Judo MMA Women Safety Training Fitness Training Yoga & Meditation Police/Defence Training

Other:

4. CERTIFICATION DETAILS

Certification Level :

Black Belt Brown Belt Blue Belt Certified Trainer State Level National Level International Level

Other:

Certificate Number :

Issued By :

Year of Certification :

5. EXPERIENCE DETAILS

Total Training Experience :

Fresher 1-2 Years 3-5 Years 5-10 Years 10+ Years

Have You Conducted Training for Girls Before?

Yes No

If Yes, Mention Details :

6. TRAINING AREAS (You can conduct)

Physical Self-Defence Leadership Development Emergency Escape Techniques Fitness & Physical Training Public Safety Awareness Women Rights Awareness School & Hostel Safety Mental Strength & Motivation Cyber Safety Awareness Awareness on Good Touch
& Bad Touch Confidence Building First Aid & Emergency Support

7. SAFETY & EMERGENCY KNOWLEDGE

Topic	Yes	No
First Aid
CPR Training
Child Protection Awareness
POCSO Awareness
Women Safety Laws
Emergency Handling

8. AVAILABILITY DETAILS

Preferred Working Areas :

Schools

Colleges

Welfare Hostels

Tribal Areas

Rural Areas

Urban Areas

Available for Travel?

Yes No

Preferred Districts :

Available Timings :

Morning Afternoon Evening Full Day

9. DOCUMENTS REQUIRED (Upload Self-Attested Copies)

Aadhar Card

Experience Certificates

Passport Size Photo

Police Verification Certificate

Educational Certificates

Medical Fitness Certificate

Martial Arts Certificates

Government ID Proof

10. WHY DO YOU WANT TO JOIN THIS PROGRAMME?

11. DECLARATION

I hereby declare that all the information provided in this application is true and correct to the best of my knowledge. I agree to follow all safety guidelines, professionalism, discipline, and child protection policies while conducting training under the Girl Safety & Self-Defence Training Programme.
I understand that misconduct or submission of false information may result in cancellation of my application.

Signature :

Date :

Name :

Place :