APPLICATION FORM

Position Applied For: Source (Direct/Consultant/Reference : Na!e in case of Consultant / Reference: Relations"ip #it" referee (If applica$le : 1. Personal Details
Na!e (In $old letters% as per &our PAN Card Paste Your Photograph

Date of 'irt" (As per ()t" !ar* s"eet Cate+or& (,eneral/ST/SC/O'C Reli+ion Marital Status 'lood ,roup -.Mail ID Contact No/ Per!anent Address Pin Code Correspondence Address Pin Code

-!er+enc& Contact Na!e 0 Nu!$er

Family Details (Include name of parents, spouse, children and siblings) Na!e A+e Occupation Relations"ip Or+ani1ation

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Please tick the appropriate boxes

Lan+ua+es 2no#n English Hindi Read 3rite Spea* 4nderstand

Hobbies Interests!
(/

". #cademic Details ($tart %ith the highest &ualification)

Degree Name of Institution Full / Part time/ Correspon dence Period (YY) From )o u!"ect/ peciali#atio n $ %ar&s or 'rade
Inter nal E*ter nal )otal Di(ision

S"ort ter! courses/ Professional Trainin+ Pro+ra!!es: 1+ ,+ Me!$ers"ip of Professional/ Political Associations

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'. (xperience Details ()se extra sheet* if re&uired)

Name of compan-. nature of !usiness / annual turno(er Designation From Period )o 0rief description of "o! responsi!ilities Cost to Companat the time of 1oining 2ea(ing

Total -5perience Rele6ant -5perience #/r/t/ t"e 7o$ applied for (&ears0 !ont"s
+utline your reporting relationship through an +rgani,ation -hart i.e. to %hom are you reporting and %ho all are reporting to you.

.emuneration Details (/ast dra%n)

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A/ Mont"l& Co!ponents !ont"

Rupees per

Rupees per annu!

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a) 0asic !) H34 c) Con(e-ance 4llo5ance d) Dearness 4llo5ance / CC4 e) Children Education f) 2unch 4llo5ance g) 0oo&s / Periodicals h) 4n- 6ther (specif-)
S4'.TOTAL (A

'/ Rei!$urse!ents / Annual Co!ponents a) %edical 3eim!ursement !) 2)4 c) Performance 0onus / E*7gratia
S4'.TOTAL ('

Rupees per !ont"

Rupees per annu!

C/ Retirals a) Pro(ident Fund !) 'ratuitc) uperannuation

S4'.TOTAL (C D/ Per8uisites

Rupees per !ont"

Rupees per annu!

Rupees per !ont"

Rupees per annu!

a) Compan- 2ease 4ccommodation (C24) !) Fi*tures / Furniture c) oft Furnishing / 8tilities d) )elephone / %o!ile e) Compan- %aintained Car / Car 2ease f) Dri(er / er(ant g) Insurance (%edical / 4ccident) h) 2oan / 2oan u!sidi) Clu! %em!ership
S4'.TOTAL (D COST TO COMPAN9 (A:':C:D

0ote! Please attach your current #ppoinment /etter Increment /etter $alary $lip supporting abo1e salary details. $)22#.3!

Current ,ross Salar& Per !ont":

;;;;;;;;;; ;;;;;;;;;;

$ Current Ta*e.<o!e Salar& Per !ont":

-=P-CT-D SALAR9 (CTC per !ont" 99999999999999999999999999999999999999999999

4. +ther Information .e&uired

a) Do -ou ha(e an- relati(e 5or&ing in 1a&son group companies: If YE ; specif- the name; relationship

and location+ !) Ha(e -ou e(er !een inter(ie5ed !efore in 1a&son: If YE ; pro(ide the inter(ie5 details and position for 5hich -ou 5ere inter(ie5ed+

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c) pecif- the details of an- ma"or illness / an- medications / treatment (in past / present if an-)

d) Ha(e -ou signed an- ser(ice / secrec- agreement 5ith -our present emplo-er: If YE ; pro(ide the salient features of the ser(ice / secrec- agreement+
e) Ha(e -ou e(er !een con(icted !- an- court of la5 in India or 4!road+

5. .eferences (' at least)

Please provide ONLY professional references. Please do not mention the names of your relatives here.
Na!e Co!pan& Desi+nation Tel / Mo$ile :;;;;;;;;;;;;;;;;;;;; :;;;;;;;;;;;;;;;;;;;; :;;;;;;;;;;;;;;;;;;;; :;;;;;;;;;;;;;;;;;;;; ;;;;;;;;;;;;;;;;;;;;; ;;;;;;;;;;;;;;;;;;;;; ;;;;;;;;;;;;;;;;;;;;; ;;;;;;;;;;;;;;;;;;;;; ;;;;;;;;;;;;;;;;;;;; ;;;;;;;;;;;;;;;;;;;; ;;;;;;;;;;;;;;;;;;;; ;;;;;;;;;;;;;;;;;;;;

6. 0otice Period

<hat is the notice period 5ith -our current emplo-er: If selected; ho5 soon can -ou "oin us:

9999999 months / da-s 9999999 da-s

78. Declaration by applicant

I certify that the information pro1ided by me in this application are complete, correct and true to the best of my kno%ledge. I hereby declare that I ha1e not %ithheld any information and understand that any false or misleading information gi1en by me in my application %ill render me liable for dismissal %ithout notice or compensation.

Place: Date: Si+nature of applicant

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