DETAILS OF REFEREES, PREVIOUS AND PRESENT EMPLOYER

I have been selected for the post of ____________________________. I submit the

details of TWO referees, present / previous employers and my present address for
communication as under: 1)

Name of Referee
Address
Telephone
Mobile No.
Fax No.
Email ID

2)

Name of Referee
Address
Telephone
Mobile No.
Fax No.
Email ID

_________________________________________
_________________________________________
_________________________________________
_________________________________________
_________________________________________
_________________________________________
_________________________________________
_________________________________________
_________________________________________
_________________________________________
_________________________________________
_________________________________________
_________________________________________
_________________________________________
_________________________________________
_________________________________________

1)

Name of Present Employer _________________________________________

Address
_________________________________________
_________________________________________
_________________________________________
Telephone
_________________________________________
Mobile No.
_________________________________________
Fax No.
_________________________________________
Email ID
_________________________________________

2)

Name of Previous
Employer
Address
Telephone
Mobile No.
Fax No.
Email ID

_________________________________________
_________________________________________
_________________________________________
_________________________________________
_________________________________________
_________________________________________
_________________________________________
_________________________________________

(Use separate sheet for details of other previous employer/s, if any)

Name of Candidate
Present Address
for communication
Telephone
Mobile No.
Fax No.
Email ID

_________________________________________
_________________________________________
_________________________________________
_________________________________________
_________________________________________
_________________________________________
_________________________________________
_________________________________________

Date : __________
Place : __________
_______________________
(Signature of Candidate)