ALKEM LABORATORIES LTD.

APPLICATION FOR EMPLOYMENT

AFFIX SIGNED
PHOTOGRAPH HERE

HEAD OFFICE :
BOMBAY

(PASSPORT SIZE)
Please complete in own handwriting.
Please add extra sheet if the space provided is not sufficient.
Use capital letters only.
01. Post Applied For :
02. Full Name (Underline Surname) :
Telephone :
Pincode
:
Email Id
:
Pan No. :

03. Present Address :

04. Permanent Address :

Telephone :
Pincode
:

05. Name of Father/Husband :

Occupation :

06. Person to be notified :

in case of Emergency

Name & Address

07. Place & Date of Birth :

Telephone :

DD/MM/YY

08. Nationality :
09. Religion :
10. Marital
Status

Single

Married

Widowed

Rent

11. Living With Parents

Divorced

Own House

Board

12. Lan gua ges : ( Underl ine Mother Tongue)

a. Speak, read and wri te :
b. Speak and read onl y :
c. Sp ea k on ly
:

P H Y S I C A L

13. Height

14. Weight

16. General condition of

Your health
17. Have you any Physical :
or Mental Handicap ?

Kg.

15. Do You
Wear
Glas ses ?

Good
No

18. Did you undergo any major :

surgery during the last
3 years ?

Fair
Yes

No

Yes
No
Excellent

Nature of :
Problem
Yes

19. List any serious illnesses you had during the last 3 year resulting in
absence from work for more than a month continuously :

Power of L :
Glasses R :

Please :
specify :

Indifferent

2
EDUCATIONAL & PROFESSIONAL QUALIFICATION

20. Degree / Diploma

Certificate
( HIGHEST DEGREE
DIPLOMA FIRST)

Class /
Divn.

University
College / School

Years Attended
From
To

Main subject /
Subjects Specialised

21. Please mention scholastic distinctions : Scholarship or Prizes :

FAMILY

22. Name of Institution/

Firm / Department

2 3. Relation

Period

Field of Specialization / Training

Name

Age

DOB

Stipend amount
if any

Dependent

Mother
Father
Spouce
Child
Child

GENERAL

24. Do you know anyone in this Organisation

Are they related to you/

25. Have you been Interviewed

by this Organisation before
26. Maximum period
spent so far

: Village

No

Yes

No

Yes

No

Yes

Town

Metro

27. Sport & Hobbies :

28. Have you ever been prosecuted in a criminal court ?
If so give details

Name & Designation

1.
2.
3.
Position for which
Interviewed
Metro Name

E M P L O Y M E N TH I S T O R Y

3
29. PLEASE START WITH PRESENT OR LAST EMPLOYMENT

Period
From
To

Employer s Name
and Address

Nature of business
and turnover of
the company

Designation / Major Last drawn

pay and
Duties & Designation
perks
of immediate superior

Reasons
for
Leaving

30. Significant contribution in your present or most recent job :

31. Can we refer to your :

Present employer ?

No

Yes

32. Our jobs are transferable anywhere in India.

Are you willing to work anywhere in India ?

No

Yes

34. How soon can you join :

if selected ?

33. Salary expectation :

R E F E R E N C E S

( Note : No reference will be made

Without your prior consent )

35. Please give names and address of two persons to whom we can refer ( Persons mentioned should hold
responsible positions and should not be relatives )

Name

Address

Occupation

Years of
Acquaintance

DECLARATION :
(a) I hereby declare that the foregoing statement and answers in this application form have been given by me after fully
understanding the questions and the same are true. Full and complete in every particular, manner to the best of my
knowledge and that I have not withheld any information.
(b) I do hereby agree and declare that If the company offer me employment, these statements and answers and this
declaration will be the basis of the contract of employment between the company and me and that if any of these
statements or answers are found to be untrue, and / or incomplete or if any information is found to have been willfully
withheld by me, I hereby agree that the company has the right to terminate my service without any compensation,
on the basis of the contract of employment being ab-initio void .

Date

Place :
Applicants Signature