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1) Please read all instructions for each section and fill in as instructed. All fields are to be filled legibly, completely and accurately in CAPITAL letters to reduce delay in processing your candidature with IBM. 2) Please bring the following documents with you to the personal interview at IBM: i) Completed IBM Employment Application Form ii) Proof of Salary Documents Offer letter with compensation break up OR Latest increment letter from present organization with compensation break-up iii) Updated Resume iv) Valid Photo ID (Passport, PAN Card, Voter’s ID card, Driver’s License)
Past IBM Interview Details (Fill in CAPITAL Letters) Have you attended any IBM Interview in the last 3 Months If Yes, please provide the below details:
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Date of Interview Position Applied
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IBM subsidiary Name IBM India Pvt Ltd IBM Daksh IBM NetSol
Page 1 of 6, Employment Application form, version 4.0, wef - 05th Mar 2012
Twitter.0.g. First Name B H A S Ms. industry and competency associations) or informal (examples of informal networks are former employment with the same company. K A R Middle Name Last Name D A S A D Date of Birth R D I M M M Y Y Y Y 3 0 A P R 1 9 8 4 **e. You also confirm that the referrer has made you aware that by referring your candidature to IBM for an opportunity of employment.Mail ID It is important that you mention the employee ID or Email ID accurately.IBM Website Agency Agency name X U S IBM Employee Referral Accepted Not Joined Candidate Name of the Employee D R A I Y R A M O J U Employee Number (If Applicable) Jobsites Job Site Name E.Mobile Number Telephone **Country code . If you are referred by an Agency. Facebook. Employment Application form. please ask your agency for the Applicant ID PERSONAL INFORMATION (Fill in CAPITAL Letters) * Enter your name as per your Passport. l c . please confirm with the referrer if you are not sure of the information By submitting the IBM Employee Referral name you confirm that the referrer is known to you personally or professionally. 01 .1900 Mobile Number 8 - 9 0 4 6 4 8 4 8 1 **Country code . wef .Telephone Number Personal Email ID b b a u c d h d A i y L D s 4 M L a 8 P F i 4 D A 2 8 1 P 0 1 6 1 1 @ 4 0 2 g 7 1 @ m H 8 g a m i a l i . IBM Application ID * C * If you have already registered on our IBM Job Portal please provide the IBM Candidate Applicant ID also called GOM Candidate Applicant ID.05th Mar 2012 2 . he/she may be eligible to receive a referral bonus. Driver's Licence OR PAN Card (For Indian Nationals) Title X Mr. This relationship may be a result on account of participation in various social networks which are either formal (examples of formal networks are Linkedin.JAN .City Code . o c m o m Pan Card (If you are an Indian National) Driver's Licence # 7 6 7 D 2 D 0 0 M 8 M M Y Y Y Y Passport Number G 5 2 7 H 2 Y 0 D 4 E 1 R A B A D Expiry 2 3 S E P 2 0 1 7 Place of Issue Refer to the passport for this information Page 2 of 6. alumni from same educational institution or study circles) . version 4. friends circle.SOURCE INFORMATION (Fill in CAPITAL Letters) How did you know about this vacancy in IBM? (Select any one of the below) Direct .
05th Mar 2012 3 . Juniors. MARUTHINAGAR . 1ST CROSS . GKVK POST. ALLALASANDRA . City State BANGALORE KARNATAKA PIN Code 560065 Country INDIA Permanent Address (If different from the above) H. Employment Application form. wef . Page 3 of 6.0. Relatives at work and Clients Name SRIDHER K Contact Number 9845188698 Nature of professional Relationship Current occupation Comments* PROJECT MANAGER PROJECT MANAGER PROJECT MANAGER IN INTEGRA MICRO SOFTWARE SERVICES PVT LTD AT & T ACCOUNT ASSOCIATE SYSTEM ASSOCIATE SYSTEM ENGINEER ENGINEER IN IBM HYDERABAD DILIP KOSURI 9959639937 SUDESHNA VUSTIPALLI 9962078674 AT & T ACCOUNT SENIOR SYSTEM ENGINEER SENIOR SYSTEM ENGINEER IN IBM CHENNAI *Please use the comments column to indicate if you do not wish IBM to contact one or any of the above for pre-reference checks. Colleagues. ADILABAD (DIST) City State MANDAMARRI ANDHRA PRADESH PIN Code 504231 Country INDIA PROFESSIONAL REFERENCES (Fill in CAPITAL Letters) Please provide details of three professional references with whom you have had a business/Working relationship of which one reference has to be mandatorily your previous Manager's details Please exclude Friends.PERSONAL INFORMATION…… CONTINUED (Fill in CAPITAL Letters) Nationality INDIAN M A N D A M A R R I City of Birth Country of Birth I N D I A Current Address #21 GOWTHAMA GIRI NILAYA . version 4. NARAYANAPPA LAYOUT .NO : 42-60/A . MANDAMARRI . 1ST MAIN ROAD .
version 4. JAN09 M A A M P P M R R Y 0 0 Y 3 7 Graduation Start Date End Date H Y D 62.please mention the details ______________________________________________________________________________________________________________________________________________ Page 4 of 6.Com B.g. B.g.0. Highest Qualification (Completed)** e.g.g.05th Mar 2012 4 .Tech * E.com / *University name is mandatory where applicable(DO NOT ABBREVIATE) Grade Points BA/ Mtech) SSLC ( 10th) Start Date End Date M M M M A A M R R Y 9 0 Y 9 0 T L D A S L D A J A R E A I N R L I N I N E R W R S D A E S D T D C A A A T H V G T H S H O B K M R R A E R R R G A K A I A N I A K A N D A K C P T D C P A P I L R T R H H T R R R S I : A I A : A I A E H S A D R W D M D D I H D E J M A E N E G N I S U A R S A S J H A L H N R A H G H N T A I A N P A S U B O M G R U C R A R A H D O O 66. B.Sc.4 INTERMEDIA TE HSLC (12th) * E. JAN09 State reasons for GAP in education. wef . JAN09 University Name M Others . CFA etc * E.EDUCATION DETAILS (Fill in CAPITAL Letters) Please complete all fields.PhD. JAN09 Start Date End Date M M M M A A M R R Y 0 0 Y 0 2 C L O 77. even if you have already provided a resume.g.Tech PLEASE MENTION COMPLETE DETAILS OF SCHOOL / COLLEGE / INSTITUTION AND UNIVERSITY NAME ALONG WITH COMPLETE ADDRESS WITH CITY & POSTAL CODE IN CAPITAL LETTERS Name of the Class/ Degree Complete Name & Address of School / College / Institution and Division/ Qualification Course Tenure Awarded Name of the University Percentage/ (e.g. JAN09 M Start Date End Date M M Y Y University Name Professional Qualification (Other than already mentioned above) like CA.82 B..: M. Start Date Additional Degrees M M Y Y End Date * E.g. Provide details on COMPLETED degree programs only.6 SECONDARY SCHOOL CERTIFICAT E * E. JAN09 University Name M Post Graduation M M Y Y Start Date End Date * E.g. Employment Application form. if any : Professional Training (includes in progress degrees) .
05th Mar 2012 5 . Please Provide Agency Name. 01-JAN-1900 Below is continuation of the above table.0.g.g. CITY & POSTAL CODE IN CAPITAL LETTERS Employment Type (Permanent Organisation Name and address /Contractual) and Tenure Band / Grade details N T E G R A M I C R O S O F T W A R E M M M Y Y D D S E R R N M C N B A S R T H Y A Y L H A N A T Y D V O I D I A A E I T G M D D E P N H A U F A L C H R O O I A T O E S T R M T B D Y E E P E A U C D T H A S C T T H C D E S 1 2 P T V H T K L M T D B 5 U A 6 G P K 5 S I D T H 5 6 E Y R 0 A 0 4 N 0 H V N 0 R T A 0 V M P 0 G 4 I A R 8 B G 0 E A 6 A L L 4 R L A 5 C D A 1 Start Date End Date D D CONTRACT Start Date End Date D D PERMANENT Start Date End Date * E. COMPLETE ADDRESS WITH STREET NAME. COMPLETE Address and Contact Number Organisation Name Complete Address 1Continue SENIOR SOFTWARE ENGINEER RESIGNATION 9845188698 Pin Code Organisation Name Complete Address Contact Number A R L T T C E D I N 0 1 C H C Y I B P L 0 O N E H R F R A E O S P Y A I S R T K P E M S E L E P V T R 7 6 C T 2Continue SOFTWARE ENGINEER RESIGNATION 9986171290 O - N 7 I 7 C B 5 6 T G 0 Y A S E L O T N O A Pin Code Organisation Name Complete Address Contact Number 0 8 0 6 7 3 4 4 9 9 9 3Continue SOFTWARE ENGINEER RESIGNATION 8880180552 Pin Code Contact Number *Current Reporting Manager will be contacted ONLY AFTER the candidate joins IBM 0 4 Years 0 2 Months Total years of experience . Serial No Designation Reasons for Leaving Reporting Manager's Name and contact number)* If Employment Type is Contractual. Do you have prior employment experience? X Yes No Serial No Organisation Name Address I PLEASE MENTION COMPLETE DETAILS OF ORGANISATION NAME. Employment Application form. Continue to fill in details of "Serial No 1" (Above) in "Serial No 1-Continue" row below. include your last three 3 employers (if applicable) even if your total service exceeds 5 years in the last 1 or 2 companies.g. Please include information on Self employment within the same period.EMPLOYMENT HISTORY (Fill in CAPITAL Letters) Provide your job history for a minimum of the last five (5) years (if applicable). Additionally.g. 01-JAN-1900 Organisation Name Address 3 H D A E 2 0 3 8 J M U A L Y 0 0 7 9 64349 Full Time Pin Code * E.(please do not include any training or internship experience) State GAP in Employment if any: GAP BETWEEN JUNE 2009 TO MAR 2010 DUE TO RECESION IN SATYAM COMPUTERS PVT LTD Page 5 of 6. E. wef . 01-JAN-1900 M M M Y Y Employee Number Full Time / Part Time 1 L O L R A E I T M R A S E P S U H R 1 6 A U G 1 1 12390 Full Time Y I B E A Pin Code H E P R M A O S R Organisation Name Address 2 T W D A 0 0 5 5 A A M P U M R G M 1 1 Y 0 1 Y AVA4XN Part Time Pin Code E R C N * E. version 4. AREA.
You must also state whether you are aware of any legal restrictions on what work you may do for IBM or an affiliated Company. please indicate if you are physically challenged ** ** IBM Corporation is an Equal Employment Opportunity Employer Do you have any non-compete obligations or conflict situations or other restrictive clauses with any party including any of your previous employers that prevent you from working for IBM India Private Limited? Yes Yes X No If yes. whether as a civilian employee or member of the military? Yes All Candidates must indicate if they have worked for the Government. what those restrictions are. Employment Application form.) (C). Name Designation Business Unit Relationship Consistent with IBM's policy on workforce diversity and in order to accommodate employee's special needs in the work environment. you must also indicate whether you had any responsibilities or were involved in activities relating to IBM or an affiliated Company. Other allowances (Rs. and all other details provided in this form. Name of Government Organization and Department Tenure Job Responsibilities Restictions ( if any) Declaration • If applicable. wef . • I understand that if any information provided by me with respect to my application for employment is found to be untrue. • I hereby authorize IBM India Private Limited and its representatives (including reference check agencies/third party vendors) to verify information provided in my application for employment and to conduct enquiries as deemed necessary by the company.05th Mar 2012 6 . • I authorize all persons who have information regarding my education. • I understand that all the details provided in this application are subject to verification. to disclose it to IBM or its representative. or if I do. Fixed Pay including statutory benefits (Rs. employment. • I confirm that the information provided by me in this application form is complete and accurate.0. All details of any such matters that I have been involved with.) Comments OTHER DETAILS (Fill in CAPITAL Letters) Have you worked for IBM earlier? If "YES". inaccurate or misleading. please indicate your preference X Yes No _______________________________________________________________________ If you are related to IBM India Private Limited employees and/or Directors (sibling / spouse/ children/in law relationships). IBM INDIA Private Limited may withdraw any offer of employment made to me or terminate my employment (If I have already joined IBM India) without notice. please provide description of disability and accommodation required: X No X No Have you worked for the Government. / Contractor Code X Yes No SNMS CLUSTER BANGALORE MANYATHA 04-May-2010 08-May-2011 SUDHARSHAN SETHI CONTRACT AVA4XN Are you willing to relocate as part of your employment with IBM? If "YES". are listed above. I have (or have had) no matters involving IBM (in any capacity whatsoever). version 4. and if so.Variable Pay (Rs. I hereby confirm that in my duties as a government employee.) (B). whether as a civilian employee or member of the military.Present Employment Compensation Details** (Fill in CAPITAL Letters) ** The information stated here must be supported with documentary evidence (Offer letter from present organization including Compensation break up details or most recent increment letter) Please mention below your annual compensation details (A). Signature: BHASKAR DASARI Place: BANGALORE Date: 27-06-2012 Page 6 of 6. that I have officially withdrawn from participating in those matters while I am discussing potential employment with IBM.) Annual Current CTC = Total of A + B + C (Rs. where IBM or any of its affiliates have been involved. please provide following details: Tenure (DD-MMM-YYYY) Business Unit Location Date of Joining Last working day Manager's Name Status (Regular/FTH/Contractor) Employee No. please provide names and relationship. If so.
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