US Technology International Private Limited

INSTRUCTIONS:
It is mandatory for you to complete the form in all respects. The information you provide must be complete and correct and the same shall be used for verification of your credentials The details on this form will be used for all official requirements should you join the organization

Please provide addresses for the last Ten years Period of Stay From To Address State Country Zip Code Contact Number . etc) Nationality Marital Status Period of stay From (mm/yy) To (mm/yy) Residence Phone Number Prominent Landmark Mobile number Permanent Address Period of stay From (mm/yy) To (mm/yy) Residence Phone Number Prominent Landmark Address History (List most recent first) . Middle. Last) Former Name / Maiden Name (if Applicable) Father's Name Date of Birth (dd/mm/yy) Gender Male Female Current Address Personal Identification (PAN No.APPLICATION FOR EMPLOYMENT US Technology International Private Limited Applicant No Location Date of Application Personal Information Full Name (First.

provide details Permanent Last Salary drawn Temporary Contractual Please tick mark the documents submitted for this employment Service Certificate Relieving letter Offer letter Any Other None (please specify) Previous Employment History (2nd last employer).g. do mention it.Please attach a copy of your relieving letter/service certificate Note: Ensure that you are descriptive wherever necessary – e. Name of Current Employer Address of Current Employer Telephone No Employee Code/No Designation Department From Employment Period To Manager's Name Manager's Contact No Manager's Email ID Can a reference taken now? Yes No Duties & Responsibilities Reasons for leaving First Salary drawn Was this Position Agency Details (if temporary or contractual). provide details Permanent Last Salary drawn Temporary Contractual Please tick mark the documents submitted for this employment Service Certificate Relieving letter Offer letter Any Other None (please specify) . please mention and state reasons for the same. If Co. If Co. is closed.g. Employee Code/ ID/ Number is mandatory. Employee Code/ ID/ Number is mandatory.Current Employer Note: Ensure that you are descriptive wherever necessary – e. If your previous employer did not provide one. Name of Employer Address of Employer Telephone No Employee Code/No Designation Department From Employment Period To Manager's Name Manager's Contact No Manager's Email ID Duties & Responsibilities Reasons for leaving First Salary drawn Was this Position Agency Details (if temporary or contractual).Education Qualification . do mention it. is closed. If your previous employer did not provide one.Please attach copy of Degree and Final year mark sheet College Name & Address University Name & Address Dates Attended From To dd/mm/yy dd/mm/yy Qualification Gained ID /Roll No Full Time Part Time Employment History (List most recent first and covering last 3 employers) . please mention and state reasons for the same.

provide details Permanent Last Salary drawn Temporary Contractual Please tick mark the documents submitted for this employment Service Certificate Relieving letter Offer letter Any Other None (please specify) References: Please provide the details of three professional references Reference (1) Name & Position held: Address: Contact Details How do you know this person? Reference (2) Name & Position held: Address: Contact Details How do you know this person? Please provide details of an Alternate professional reference. Name & Position held: Company Name: Address: Tel. We undertake not to contact your present employer until your consent is gained. in case the above are unavailable.Please attach a copy of your relieving letter/service certificate Name of Employer Address of Employer Telephone No Employee Code/No Designation Department From Employment Period To Manager's Name Manager's Contact No Manager's Email ID Duties & Responsibilities Reasons for leaving First Salary drawn Was this Position Agency Details (if temporary or contractual). in the event of my obtaining employment. Signature: Name: Date: . I confirm that the above information is correct to the best of my knowledge and I understand that any misrepresentation of information on this application form may. result in action based on company policy.Previous Employment History (3rd last employer). educational institutes etc. I authorize former employers. No How do you know this person Declaration and Authorization I hereby authorize US Technology International Private Limited (or a third party agent appointed by the Company) to contact any former employers as indicated above and carry out all Background Checks not restricted to education and employment deemed appropriate through this selection procedure. agencies. to release any information pertaining to my employment/education and I release them from any liability in doing so.