Employment Application Form

Please affi- your passport si.e photo here

Please read the below instructions carefully before you start filling in the requested information:

.) Please read all instructions for each section and fill in as instructed1 ll fields are to be filled legibly( completely and accurately in C PI5 + letters to reduce delay in processing your candidature with IBM1 Please fill the applicable fields ,*$( and not applicable fields needs to be left B$A*/0 2) Please bring the following documents with you to the personal interview at IBM: i) Completed IBM Employment pplication !orm ii) Proof of "alary #ocuments 6ffer letter with compensation brea7 up 6% +atest increment letter from present organi8ation with compensation brea73up iii) $pdated %esume iv) &alid Photo I# 'Passport( P ) Card( &oter*s I# card( #river*s +icense)
Past IBM Interview etails !Fill in "API#A$ $etters% (es
, ,

&ave you attended any IBM Interview in the last ' Months If (es+ please provide the below details:
# # M M M , ,

) *o

ate of Interview Position Applied

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Work in Progress

Received Offer

Rejected/Declined

$ocation ,f Interview
IBM subsidiary *ame IBM India Pvt Ltd IBM Daksh IBM NetSol
.

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Page . of /( Employment pplication form( version 012( wef 3 .2th !eb 22.4

1,23"E I*F,3MA#I,* !Fill in "API#A$ $etters%

&ow did you 4now about this vacancy in IBM5 !1elect any one of the below%
Direct - IBM We site

!genc" Agency name

IBM #$%lo"ee Referral *ame of the Employee

!cce%ted Not &oined 'andidate

Employee *umber !If Applicable% 6obsites 6ob 1ite *ame E7 Mail I

It is important that you mention the employee I or Email I accurately+ please confirm with the referrer if you are not sure of the information

By submitting the IBM Employee 3eferral name you confirm that the referrer is 4nown to you personally or professionally0 #his relationship may be a result on account of participation in various social networ4s which are either formal !e-amples of formal networ4s are $in4edin+ Faceboo4+ #witter+ industry and competency associations% or informal !e-amples of informal networ4s are former employment with the same company+ friends circle+ alumni from same educational institution or study circles% 0 (ou also confirm that the referrer has made you aware that by referring your candidature to IBM for an opportunity of employment+ he;she may be eligible to receive a referral bonus0

IBM Application I 8

C
also called <,M "andidate Applicant

8 If you have already registered on our IBM 6ob Portal please provide the IBM "andidate Applicant I I 0 If you are referred by an Agency+ please as4 your agency for the Applicant I

PE31,*A$ I*F,3MA#I,* !Fill in "API#A$ $etters% 8 Enter your name as per your Passport+ river9s $icence ,3 PA* "ard !For Indian *ationals%
#itle Mr0 First *ame Middle *ame Ms0

$ast *ame

M ate of Birth

99e1g1 2. 3 : ) 3 .;22

Mobile *umber 99Country code 3 Mobile )umber #elephone Personal Email I 3 99Country code 3 City Code 3 5elephone )umber

Pan "ard

'If you are an Indian )ational)

river9s $icence :

Passport *umber
E-piry

Place of Issue %efer to the passport for this information

Page 2 of /( Employment pplication form( version 012( wef 3 .2th !eb 22.4 2

PE31,*A$ I*F,3MA#I,*== ",*#I*2E

!Fill in "API#A$ $etters%

*ationality

"ity of Birth

"ountry of Birth

"urrent Address 8 &ouse;Flat *o0 8 1treet !"ross > Main% 8 "ity 8 1tate 8"ountry Point of 3eference: along with "ontact details *ame of the contact Phone *o0: #enure of 1tay at the Address
8 1tart ate !MMM;((% 8 End ate !MMM;((%

8PI* "ode

Permanent Address !If different from the above% 8 &ouse;Flat *o0 8 1treet !"ross > Main% 8 "ity 8 1tate 8"ountry Point of 3eference: along with "ontact details *ame of the contact Phone *o0: #enure of 1tay at the Address
8 1tart ate !MMM;((% 8 End ate !MMM;((%

8PI* "ode

9 Present ddress: ddress where your are currently staying 99 Permanent ddress: ddress where you are permanently residing( irrespective of Present address1 5his is typically your parent*s residence or an address in your home town1 - %eference: Could be your Parents( "pouse( )eighbours( !riends( %elatives( %oom mate who stayed with you etc1 or staying in close neighborhood )ote: ll fields are Mandatory as per applicability

P3,FE11I,*A$ 3EFE3E*"E1 !Fill in "API#A$ $etters%

Please provide details of three professional references with whom you have had a business;?or4ing relationship of which one reference has to be mandatorily your previous Manager9s details Please e-clude Friends+ "olleagues+ 6uniors+ 3elatives at wor4 and "lients
*ame "ontact *umber *ature of professional 3elationship "urrent occupation "omments8

8Please use the comments column to indicate if you do not wish IBM to contact one or any of the above for pre7reference chec4s0

Page < of /( Employment pplication form( version 012( wef 3 .2th !eb 22.4

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E 2"A#I,* E#AI$1 !Fill in "API#A$ $etters%

Please complete all fields+ even if you have already provided a resume0 Provide details on ",MP$E#E &ighest Aualification !"ompleted%88 e1g1: M1"c( B1Com
99 =ighest education declared has to be minimum 22 year degree or diploma awarded by a $niversity or a Board or its affiliates

degree programs only0

P$EA1E ME*#I,* ",MP$E#E

E#AI$1 ,F 1"&,,$ ; ",$$E<E ; I*1#I#2#I,* A* 2*I@E31I#( *AME A$,*< ?I#& ",MP$E#E A

3E11 ?I#& "I#( > P,1#A$ ", E I* "API#A$ $E##E31 "lass; 3egistration ; ivision; 3oll ; Final (ear 1eat Percentage; *umber <rade Points *ame of the egree Awarded 'e1g11 B1com ? B ? Mtech)

Aualification

"ourse #enure

"omplete *ame > Address of 1chool ; "ollege ; Institution and *ame of the 2niversity 82niversity name is mandatory where applicable! , *,# ABB3E@IA#E% ( (

M
1tart ate 11$" ! BCth% End ate (ear of Passing

9 E1g1 : )2; M
1tart ate &1$" !BDth% End ate (ear of Passing

9 E1g1 : )2; M
<raduation 1tart ate End ate (ear of Passing
2niversity *ame

9 E1g1 : )2; M
1tart ate Post <raduation End ate (ear of Passing
2niversity *ame

9 E1g1 : )2; M
,thers 7 Ph + 1tart ate Additional egrees End ate (ear of Passing
2niversity *ame

9 E1g1 : )2;
Professional Aualification 1tart ate !,ther than already End ate mentioned above% li4e "A+ (ear of Passing "FA etc

9 E1g1 : )2; 1tate reasons for <AP in education+ if any : Professional #raining !includes in progress degrees% 7 please mention the details >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> Page 4 of /( Employment pplication form( version 012( wef 3 .2th !eb 22.4 --4

EMP$,(ME*# &I1#,3( !Fill in "API#A$ $etters%

Provide your Fob history for a minimum of the last five !G% years !if applicable%0 1tarting with you present or most recent employer0 Additionally+ include your last three ' employers !if applicable% even if your total service e-ceeds G years in the last B or D companies0 Please include information on 1elf employment within the same period0
o you have prior employment e-perience5 (es *o

P$EA1E ME*#I,* ",MP$E#E 1erial *o

,rganisation *ame Address

E#AI$1 ,F ,3<A*I1A#I,* *AME+ ",MP$E#E A

,rganisation *ame and address

3E11 ?I#& 1#3EE# *AME+ A3EA+ "I#( > P,1#A$ ", E I* "API#A$ $E##E31 Employment #ype !Permanent ;"ontractual% and #enure Band ; <rade details # 1tart ate End ate 9 E1g1 2.3: )3.;22 # 1tart ate End ate 9 E1g1 2.3: )3.;22 # 1tart ate End ate 9 E1g1 2.3: )3.;22 # M M M , , # M M M , , # M M M , ,

Employee *umber

Full #ime ; Part #ime

B Pin "ode
,rganisation *ame Address

D Pin "ode
,rganisation *ame Address

' Pin "ode

Below is continuation of the above table0 E0g0 "ontinue to fill in details of E1erial *o BE !Above% in E1erial *o B7"ontinueE row below0
1erial *o esignation 3easons for $eaving 3eporting Manager9s *ame and contact number%8 If Employment #ype is "ontractual+ Please Provide Agency *ame+ ",MP$E#E Address and "ontact *umber

,rganisation *ame "omplete Address

B7 "ontinue

Pin "ode ,rganisation *ame "omplete Address

"ontact *umber

D7 "ontinue

Pin "ode ,rganisation *ame "omplete Address

"ontact *umber

'7 "ontinue

Pin "ode

"ontact *umber

8"urrent 3eporting Manager will be contacted ,*$( AF#E3 the candidate Foins IBM #otal years of e-perience 7 !please do not include any training or internship e-perience% "tate @ P in Employment if any: (ears Months

Page A of /( Employment pplication form( version 012( wef 3 .2 !eb 22.4

Present Employment "ompensation etails88 !Fill in "API#A$ $etters%

88 #he information stated here must be supported with documentary evidence !,ffer letter from present organi.ation including "ompensation brea4 up details or most recent increment letter% Please mention below your annual compensation details !A%0 !iEed Pay including statutory benefits '%s1) !B%0&ariable Pay '%s1) !"%0 6ther allowances '%s1)

nnual Current C5C F 5otal of G B G C '%s1)

"omments

,#&E3 E#AI$1 !Fill in "API#A$ $etters%

&ave you wor4ed for IBM earlier5 If E(E1E+ please provide following details:
#enure ! Business 2nit $ocation ate of 6oining 7MMM7((((% $ast wor4ing day Manager9s *ame 1tatus !3egular;F#&;"ontractor% Employee *o0 ; "ontractor "ode

(es

*o

Are you willing to relocate as part of your employment with IBM5

If E(E1E+ please indicate your preference

(es
Preference B

*o
Preference D

If you are related to IBM India Private $imited employees and;or irectors !sibling ; spouse; children;in law relationships%+ please provide names and relationship0 *ame esignation Business 2nit 3elationship

Consistent with IBMBs policy on wor7force diversity and in order to accommodate employeeBs special needs in the wor7 environment( please indicate if you are physically challenged 99 88 IBM "orporation is an Equal Employment ,pportunity Employer #o you have any non3compete obligations or conflict situations or other restrictive clauses with any party including any of your previous employers that prevent you from wor7ing for IBM India Private +imitedD (es *o (es *o If yes( please provide description of disability and accommodation reCuired:

&ave you wor4ed for the <overnment+ whether as a civilian employee or member of the military5

(es

*o

ll Candidates must indicate if they have wor7ed for the @overnment( whether as a civilian employee or member of the military1 If so( you must also indicate whether you had any responsibilities or were involved in activities relating to IBM or an affiliated Company1 ,ou must also state whether you are aware of any legal restrictions on what wor7 you may do for IBM or an affiliated Company( and if so( what those restrictions are1 *ame of <overnment ,rgani.ation and epartment #enure 6ob 3esponsibilities 3estictions ! if any%

eclaration

H If applicable+ I hereby confirm that in my duties as a government employee+ I have !or have had% no matters involving IBM !in any capacity whatsoever%+ or if I do+ that I have officially withdrawn from participating in those matters while I am discussing potential employment with IBM0 All details of any such matters that I have been involved with+ where IBM or any of its affiliates have been involved+ are listed above0 H I confirm that the information provided by me in this application form is complete and accurate0 H I understand that if any information provided by me with respect to my application for employment is found to be untrue+ inaccurate or misleading+ IBM I* IA Private $imited may withdraw any offer of employment made to me or terminate my employment !If I have already Foined IBM India% without notice0 H I understand that all the details provided in this application are subFect to verification0 H I hereby authori.e IBM India Private $imited and its representatives !including reference chec4 agencies;third party vendors% to verify information provided in my application for employment and to conduct enquiries as deemed necessary by the company0 H I authori.e all persons who have information regarding my education+ employment+ and all other details provided in this form+ to disclose it to IBM or its representative0

1ignature:

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ate:

BA"/<3,2* "&E"/ APP$I"A#I,* F,3M IBM India Pvt $td0 I*1#32"#I,*1 : 88 Fields which are coloured in grey needs to be updated manually0 3est of the fields gets auto populated from the first I sheets of Employment Applicaion Form !EAF%0 Auto populated fields are being loc4ed+ hence the candidates will not be able to edit them in B<" Form0 For any changes in data EAF needs to be updated0 Ensure to sign mandatorily at the bottom of the form0

)ame of pplicant #ate of Birth )ationality !atherBs )ame 33

"urname @ender Passport )o C

Middle

!irst )ame

IBM @6M Code ? IBM Employee I# "urrent Address 9 =ouse?!lat )o1 9 "treet 'Cross H Main) 9 City 9 "tate 9Country 9PI) Code

Permanent Address !If different from the above% 9 =ouse?!lat )o1 9 "treet 'Cross H Main) 9 City 9 "tate 9Country 9PI) Code Point of 3eference: along with "ontact details )ame of the contact Phone )o1: #enure of 1tay at the Address 9 "tart #ate 'MMM?,,) 9 End #ate 'MMM?,,)

Point of 3eference: along with "ontact details )ame of the contact Phone )o1: #enure of 1tay at the Address 9 "tart #ate 'MMM?,,) 9 End #ate 'MMM?,,)

9 Present ddress: ddress where your are currently staying 99 Permanent ddress: ddress where you are permanently residing( irrespective of Present address1 5his is typically your parent*s residence or an address in your home town1 - %eference: Could be your Parents( "pouse( )eighbours( !riends( %elatives( %oom mate who stayed with you etc1 or staying in close neighborhood )ote: ll fields are Mandatory as per applicability

Proof of name change attached if applicable "ocial "ecurity - ? )ational Insurance -

,es *,# APP$I"AB$E

E 2"A#I,* !Please mention only highest completed education as declared in Employment Application Form%

)ame of #egree ? #iploma

lso indicate "peciali8ation of the #egree ? #iploma

)ame H +ocation of "chool?College?Institute 'also mention whether course attended is %egular?correspondence) )ame H +ocation of university to which the college?Institute is affiliated to #ates attended ,ear of passing %oll )umber ? %egistration )umber ? EEam "eat )umber *ote : If you are a Fresher+ please specify E *AE in all the fields below0 EMP$,(ME*# 3E",3 : 1tarting with your present or most recent employer+ please list last ' employments in chronological order0 ?hen listing consulting or temporary assignments under EEmployerE+ state the name of the consulting or temporary agency that placed you at the client site "233E*# ; M,1# 3E"E*# EMP$,(E3 ! "ompany *ame % : Employee I# : !rom '## ? MM ? ,,,,) : Complete ddress Postal Code :ob 5itle : %eason for +eaving : ,utsourcing Agency etails : 7 )ame !ull ddress Employment status'%egular?5emporary) : 33 5o '## ? MM ? ,,,,) : 33 !rom MM ? ,,,, 5o MM ? ,,,,

Pin code P3E@I,21 EMP$,(E3 !P3I,3 #, #&E M,1# 3E"E*#% ! "ompany *ame % : Employee I# : !rom '## ? MM ? ,,,, : Complete ddress Postal Code 33 5o '## ? MM ? ,,,, : 33 I

:ob 5itle : %eason for +eaving : ,utsourcing Agency etails : 7 )ame !ull ddress

Employment status'%egular?5emporary) :

Pin code 1E",* P3E@I,21 EMP$,(E3 ! "ompany *ame % : 33 5o '## ? MM ? ,,,, : I 33

Employee I# : !rom '## ? MM ? ,,,, : Complete ddress Postal Code :ob 5itle : %eason for +eaving : ,utsourcing Agency etails : 7 )ame !ull ddress Employment status'%egular?5emporary) : ---

Pin code

I*F,3MA#I,* 3E$EA1E A2#&,3IJA#I,* ! #, BE 1I<*E B( #&E "A* I A#E% I certify that the statements made in this application are valid and complete to the best of my 4nowledge0 I understand that false or misleading information may result in termination of employment0 If upon investigations+ any of this information is found to be incomplete or inaccurate+ I understand that I will be subFect to dismissal at any time during my employment0 I hereby authori.e IBM and ;or any of its subsidaries or affiliates+ and any persons or organi.ations acting on its behalf to verify the information presented on this application form and to procure an investigative report or consumer report for that purpose0 I hereby grant authority for the bearer of this letter to access or be provided with full details of my previous records0 In addition+ please provide any other pertinent information requested by the individuals presenting this authority0 I hereby release from liability all persons or I authori.e to contact my present employer I have read+ understand and by my signature consent to these statements0

1ignature :

ate > Place :