EMPLOYMENT APPLICATION FORM

POST APPLIED FOR:

Sr. ENGINEER/ASSISTANT MANAGER

FULL NAME IN BLOCK LETTERS

RAJAT
(LAST)

(FIRST)

PRESENT HOME MAILING ADDRESS:

PLEASE AFFIX
YOUR RECENT
PASSPORT SIZE
PHOTOGRAPH

(MIDDLE)

WARD NO 7 BHAGVAN GALI NARNAUND

WARD NO 7 H.NO 34 BHAGVAN GALI PAID PANNA

CITY NARNAUD DIST .HISAAR

PIN CODE 125039

TELEPHONE (With Code)

CELL:

8398883888

rajat9888@gmail.com

E-MAIL :

PERMANENT HOME MAILING ADDRESS:

BIRTH DATE

C/O KRISHAN POPLI

29/03/1994

WARD NO 7 H.NO 34 BHAGVAN GALI PAID PANNA

AGE (YRS)

NARRNAUND (HISSAR)

PIN CODE 125039

TELEPHONE (With Code)

PERSONAL DATA

GENDER

CELL:
MARRIAGE DATE

MARITAL STATUS

MALE

(If Married)

CASTE

ST

DT

NT

LANGUAGES KNOWN (Including Foreign)

SBC

ENGLISH
HINDI

8398883888

HANSI

RELIGION

NATIONALITY

STATE OF DOMICILE

HARYANA

HINDU

INDIAN

HARYANA

OBC

SPEAK

BIRTH PLACE

NATIVE STATE

SINGLE

SC

22

GEN.CAT

READ

[Other than GEN.CAT please arrange to produce Caste Certificate]

WRITE

ODIA

PASSPORT NO.
PASSPORT ISSUE DATE
VALID UPTO DATE
COUNTRY OF ISSUE
AADHAR NO.

463813255077

PAN NUMBER

CEJPR9243H
55074329587(SBP)

BANK A/C DETAILS

DETAILS OF FAMILY MEMBERS (parents, spouse, children, siblings & any other dependents excluding self)
NAME

RELATIONSHIP

DATE OF BIRTH

QUALIFICATION

OCCUPATION

SUNITA POPLI

MOTHER

8/10/1967

STNO

HOUSE-WIFE

KRISHAN

FATHER

3/8/1966

12TH

KANIKA

SISTER

7/7/1997

GRADUATE
STUDENT

HEALTH DATA

EMERGENCY CONTACT DETAILS

NAME

WARD NO 7 H.NO 34 BHAGVAN GALI PAID PANNA

RELATION

FATHER

TELEPHONE NO.

WEIGHT (kg)

BLOOD GROUP

173

62

0+

BUSINESS

KRISHAN POPLI

ADDRESS

HEIGHT (cms)

ORGANIZATION AND POSITION

8053155988

EYESIGHT [SPECIFY POWER IF WEARING GLASSES/LENSES]

Right

PHYSICAL DISABILITY (IF ANY)

NO

Left

CUT MARK ON LEFT SHOULDER

IDENTIFICATION MARKS

EDUCATION
EXAMINATION PASSED

SPECIALISATI
ON

SCHOOL / COLLEGE /
INSTITUTION

UNIVERSITY/
BOARD

WHETHER
FULLTIME /
PARTTIME/
CORRES.

DURATION OF
COURSE
(Yrs & Mths)

MONTH &
YEAR OF
PASSING

GRADE %
MARKS

DISTINCTIONS /
SCHOLARSHIPS / PRIZES
WON

SSC OR Equivalent
School leaving Certificate

MATH,
SCIENCE
ENGLISH,ODI
A

HBSE

FULL TIME

1YR

2009

79

SCIENCE

TAGORE SR SEC
SCHOOL

HBSE

FULL TIME

1YR

2011

79

EE

INDUS INSTITUTE OF
ENGG. AND TECH .

KUK

FULL TIME

4YRS

2015

71.8

B.TECH

POST. GRAD. DEGREE /

DIP. CERTIFICATE

DEGREE (S)

Intermediate or
12th standard / HSC

TAGORE SR SEC
SCHOOL

MEMBERSHIP OF PROFESSIONAL INSTITUTE

NAME OF INSTITUTE

TYPE OF MEMBERSHIP AND POSITION HELD

PERIOD

DURATION OF MEMBERSHIP
FROM

TO

TRAINING / CERTIFICATIONS
NAME OF THE TRAINING COURSE

DURATION

YEAR

INSTITUTE / ORGANISATION

WHETHER CERTIFICATE
AWARDED

TRANSMISSON AND DISTRIBUTION

1 MONTH

2013

HMT PINJORE

YES

PAPERS PUBLISHED / PRESENTED

TITLE

NAME & DATE OF THE SEMINAR / JOURNAL IN WHICH PRESENTED / PUBLISHED

EXTRA CURRICULAR ACTIVITY (E.G. Sports, Social & Literary activities etc.)
ACTIVITY

INSTITUTION/ASSOCIATION/SOCIETY/CLUB

YEAR

POSITION HELD

PRIZES WON

SKILLS SUMMARY
(Give brief details for the projects you have worked on)
PROJECT TITLE

ROLE

TEAM SIZE

DURATION

LANGUAGE / PLATFORM / OS

ELECTRICAL BOAT

AS A BASIC MODEL OF BOAT IN LARGE SEA

2013- 2014

ELECTRICAL BOAT

ELECTRICAL BOAT WITH ALTERNATE

SOLAR TECHNOLOGY

AS A BASIC MODEL OF BOAT IN LARGE SEA

2014- Present

ELECTRICAL BOAT

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) [Please attach extra sheet if required]
EMPLOYER'S NAME
& ADDRESS

DURATION
PERIOD(Yrs.)

LAST POSITION HELD DESIGNATION

NATURE OF DUTIES

SENIOR ENGINEER

TO

GROSS EMOLUMENTS Rs.

Per month

Employee Code

EMPLOYER'S NAME
& ADDRESS

Details of Current
Emoluments
DURATION
PERIOD(Yrs.)

AT THE TIME OF JOINING

BASIC (P.M.)

FIXED (P.A.)

LAST POSITION HELD DESIGNATION

VARIABLE (P.A.)

GROSS (P.A.)

NATURE OF DUTIES

FROM
NAME & DESIGNATION OF IMMEDIATE SUPERIOR
TO
Employee Code
GROSS EMOLUMENTS Rs.
Per month

EMPLOYER'S NAME
& ADDRESS

DURATION
PERIOD(Yrs.)

AT THE TIME OF JOINING

LAST DRAWN

LAST POSITION HELD DESIGNATION

NATURE OF DUTIES

FROM
NAME & DESIGNATION OF IMMEDIATE SUPERIOR
TO
Employee Code
GROSS EMOLUMENTS Rs.
Per month

EMPLOYER'S NAME
& ADDRESS

DURATION
PERIOD(Yrs.)

AT THE TIME OF JOINING

LAST DRAWN

LAST POSITION HELD DESIGNATION

NATURE OF DUTIES

FROM
NAME & DESIGNATION OF IMMEDIATE SUPERIOR
TO
Employee Code
GROSS EMOLUMENTS Rs.
Per month

EMPLOYER'S NAME
& ADDRESS

DURATION
PERIOD(Yrs.)

AT THE TIME OF JOINING

LAST DRAWN

LAST POSITION HELD DESIGNATION

NATURE OF DUTIES

FROM
NAME & DESIGNATION OF IMMEDIATE SUPERIOR
TO
Employee Code
GROSS EMOLUMENTS Rs.
Per month

EMPLOYER'S NAME
& ADDRESS

DURATION
PERIOD(Yrs.)

AT THE TIME OF JOINING

LAST DRAWN

LAST POSITION HELD DESIGNATION

NATURE OF DUTIES

FROM
NAME & DESIGNATION OF IMMEDIATE SUPERIOR
TO
Employee Code
GROSS EMOLUMENTS Rs.
Per month

AT THE TIME OF JOINING

LAST DRAWN

DRAW IN BRIEF THE ORGANISATION STRUCTURE OF THE COMPANY WHERE YOU ARE PRESENTLY EMPLOYED INDICATING TWO
LEVELS ABOVE AND ONE LEVEL BELOW YOUR POSITION (PLEASE ALSO INDICATE THE TOTAL NUMBER OF PERSONS UNDER YOU)

WHAT ARE YOUR SIGNIFICANT ACHIEVEMENTS AND EXPLAIN WHY YOU CONSIDER YOURSELF SUITED FOR THE POSITION :

HAVE YOU EVER BEEN INTERVIEWED BY SHYAM INDUS POWER SOLUTIONS PVT. LTD.?

YES

NO

DATE/YEAR

POSITION

COMPANY

If Yes, give
details

RELATIVES / ACQUAINTANCE IN SHYAM INDUS POWER SOLUTIONS PVT. LTD.

NAME

RELATIONSHIP

POSITION

COMPANY & TELEPHONE NOS.

GENERAL DATA

NA

HOW DID YOU COME TO KNOW OF THIS POSITION?

BY CAMPUS OF IIET

ARE YOU ENGAGED IN ANY PERSONAL BUSINESS ?

YES

NO

DO YOU HAVE ANY CONTRACT / BOND

WITH YOUR PRESENT EMPLOYER?
YES

NO

if YES,
indicate nature of
business
if YES,
Give Details

IF SELECTED, WHEN CAN YOU JOIN?

NAME, ADD., AND TEL Nos. OF TWO SUPERIORS FAMILIAR WITH YOUR WORK (NOT RELATIVES)

CRIMINAL
RECORD

NAME

COMPANY & POSITION

TELEPHONE NOS.

E-MAIL ID

HAVE YOU EVER BEEN INVOLVED IN ANY CRIMINAL PROCEEDINGS / CONVICTED OF ANY OFFENCE? IF YES, GIVE DETAILS

DECLARATION UNDER SECTION 314 OF COMPANIES ACT, AS AMENDED IN 1974 (Tick whichever is 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
I hereby declare that I am a partner or relative of

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 service 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

JIND

DATE

7-Apr-16

Applicant's Signature