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EMPLOYMENT APPLICATION
Company Name

POST APPLIED FOR

To be filld in by the applicant clearly

and completely

ADVT REF

HOW
DO YOU
( SURNAME
) PREFER YOUR
( FIRST NAME )
( MIDDLE NAME
NAME WITH INITIALS TO BE
STATED IN WRITTEN
PRESENT
HOME / MAILING
ADDRESS / ADDRESS FOR COMMU
COMMUNICATION
?

Please affix your recent Photograph

TEL NO.
(with STD)

CITY

PERSONAL

DATA

PIN CODE
EMAIL
PERMANENT HOME ADD

MOBILE NO
CITY
PIN CODE
TEL NO

AGE (Yrs)
BIRTH DATE
SEX
NATIONALITY
RELIGION
MARITAL STATUS
BIRTH PLACE
STATE OF DOMICILE
NO. OF CHILDREN
NATIVE STATE
PERIOD OF STAY IN STATE WHERE RESIDING NOW ( YRs )
PRESENT
ACCOMMODATION
Monthly Rental / Charges
( Select appropriate option from the RENTAL
Paid for Accommodation
list )
Languages Speak
Read
Write
Y
Y
LANGAGUE Marathi Y
English
Y
Y
Y
S
Hindi
Y
Y
Y
KNOWN
( Start with Gujarathi
Y

Mother
Tounge)
FATHER'S NAME

Date of
Birth

DETAILS OF OCCUPATION (IF RETIRED, STATE LAST OCCUPATION)

DETAILS OF FAMILY MEMBERS

(Please give full details of family members including parents, spouse, children and
anyother dependents)
Date of
Name

Birth

Relationship

Occupation

Duration of
Course

EDUCATION DETAILS
EXAMINATION

PASSEDSPECIALISATION
SUBJECT

FULL /
PART TIME

YRS

MTHS

SCHOOL /
NAME OF
COLLEGE
UNIVERSIT
INSTITUTIO
Y
N

GRADE
%
MARKS

DEGREE /
DISTINCTIONS /
DIPLOMA
YEAR OF
CERTIFICAT SCHOLARSHIPS /
PASSING
PRIZES WON
E
AWARDED

SSC or Equivalent
School Leaving Certificate

Post Grad. Degree /

Diploma Certificate

DEGREE

DIPLOMA

Intermediate or
12th Standard / HSC

MEMBERSHIP OF PROFESSIONAL INSTITUTION

NAME OF INSTITUTE

TYPE OF MEMBERSHIP AND POSITION HELD

PERIOD

DURATION OF MEMBERSHIP
FROM

TO

Duration

Year

Institute / Orgazination

Training

Name of the
Training Course

NAME & DATE OF THE SEMINAR/JOURNAL IN WHICH P

PUBLISHED

CRIMINAL RECORD

HEALTH DATA

EXTRA
CURRICULAR
ACTIVITY
(e.g. sports,social
& Literary
activities etc.)

Papers
Published /
Presented

TITLE

ACTIVITY

INSTITUTION /
ASSOCIATION
SOCIETY / CLUB

HEIGHT (cms)

WEIGHT
(Kg)

MOST RECENT
SERIOUS
ILLNESS

FROM

YEAR

POSITION HELD

POWER OF
IDENTIFICATION MARKS
GLASSES, If any

TO

NO. OF
DAYS

NATURE OF ILLNESS

Have you ever been involved in any criminal proceedings / convicted of any offence ?
If yes, Please give details

III

Whether Certificate
Awarded

INAR/JOURNAL IN WHICH PRESENTED /

PUBLISHED

PRIZES WON

PHYSICAL DISABILITY
IF ANY

NATURE OF ILLNESS

cted of any offence ?

WORK EXPERIENCE
In unbroken chronological order starting from your present employment and ending with first employment
(please account for all the periods of time not covered by education / training)
EMPLOYER'S NAME &
ADDRESS
(Please give Full
address)

DURATION

LAST POSITION HELD / DESIGNATION

From

NATURE OF DUTIES

GROSS EMOLUMENTS
(Rs. PER MONTH)
AT THE TIME OF JOINING

TO

NAME & DESIGNATION OF IMMEDIATE

SUPERVISOR

LAST DRAWN

No. of Yrs.
From

LAST POSITION HELD / DESIGNATION

AT THE TIME OF JOINING

TO

NAME & DESIGNATION OF IMMEDIATE

SUPERVISOR

LAST DRAWN

No. of Yrs.
From

LAST POSITION HELD / DESIGNATION

AT THE TIME OF JOINING

TO

NAME & DESIGNATION OF IMMEDIATE

SUPERVISOR

LAST DRAWN

From

LAST POSITION HELD / DESIGNATION

AT THE TIME OF JOINING

TO

NAME & DESIGNATION OF IMMEDIATE

SUPERVISOR

LAST DRAWN

No. of Yrs .
From

LAST POSITION HELD / DESIGNATION

AT THE TIME OF JOINING

TO

NAME & DESIGNATION OF IMMEDIATE

SUPERVISOR

LAST DRAWN

No. of Yrs .
From

LAST POSITION HELD / DESIGNATION

AT THE TIME OF JOINING

TO

NAME & DESIGNATION OF IMMEDIATE

SUPERVISOR

LAST DRAWN

No. of Yrs .
From

LAST POSITION HELD / DESIGNATION

AT THE TIME OF JOINING

TO

NAME & DESIGNATION OF IMMEDIATE

SUPERVISOR

LAST DRAWN

No. of Yrs .

DETAILS OF CURRENT EMOLUMENTS

ANNUAL BENEFITSMONTHLY EMOLUMENTS

PARTICULARS

SUB TOTAL (A)

SUB TOTAL (B)

EMOLUMENTS
MONTHLY (Per Month)

YEARLY
(Rs.)

Present
(Rs. p.m.)

0
0
0
0
0
0
0
0
0
0
0
0.00
0
0
0
0
0
0
0

Expected
(Rs. p.m.)

RETIREMENT
BENEFITS

0
0

SUB TOTAL (C)

0.00

0.00

Medical
Reimbursement
Limit

GRAND TOTAL (A+B+C)

TS

Per Month)
Proposed
(to be filled by HR)

Particulars

Present

OTHER PERQUISITES

Sr.No.

VI

Proposed
(to be filled in by
HR Dept

Draw in the brief organisation structure of the Company where you are presently employed
indicating two levels above you and one level below your position. (Please also indicate the
total number of persons under you).

SIGNIFICANT ACHIEVEMENTS :
mention some of the major contributions made by you in your present and previous jobs :

EXPLAIN WHY YOU CONSIDER YOURSELF SUITABLE FOR THE POSITION

VII

RELATIVES / ACQUAINTANCE IN OUR GROUP OF COMPANIES

NAME
RELATIONSHIP

Who referred you to us ?

POSITION

COMPANY

Are you engaged in any Personal Business ?

If yes, indicate nature of business

DO YOU HAVE ANY CONTRACT / BOND WITH YOUR PRESENT EMPLOYER

If Yes, Please give details

If selected, when can you join ?

Name & addresses of Two references. (Not Relatives)

DECLARATION UNDER SECTION 314 OF COMPANIES ACT, AS AMENDED IN 1974

( Strike out whichever is not applicable )
I hereby declare that I am not connected with any of the Directors of the Company as his
partner or his relative as defined under Section 6 of the Companies Act, 1956.
OR
I hereby declare that I am a partner or relative of
Mr. A Director of the Company as .
I declare that the information given above is true to the best of my knowledge. I am aware
that any false or incorrect information by me may result in termination of my services with
the Company. I have no objection to your inquiring from any of my previous employers on
any matters pertaining to me, if I join your Company

Place :
Date :

Applicant's Signature