(Please paste

recent passport
size photograph)

APPLICATION FORM
(To be filled by applicant)

Position applied for: ___________________

Location:_______________
Name in Full:
Permanent Address

Present Address

(in case of same as present address, please mention

address of your native place)

Address for correspondence would be

Address

Present Address

Permanent

(please select appropriate box)

E-mail :

Driving License Number:

Residential Tel No:

Mobile :

Pan No.:

Contact Person & Contact No. (in

case of Emergency):

Passport Number:
Date of expiry:

Date of Birth :

Place of Birth:________________
District: ___________
State:_____________

Nationality :

Blood Group:

Height (cms)

Weight (Kgs):
FAMILY DETAILS

(Spouse, Father, Mother, Dependant Brother & Sister, children)

Name

Relationshi
p

Date of
Birth

LAFARGE AGGREGATES & CONCRETE INDIA PVT. LTD.

Equinox Business Park (Peninsula Techno Park),
Tower-3, East Wing, 4th floor, Off Bandra - Kurla Complex,
LBS Marg, Kurla (West), Mumbai-400070, India

Dependa
nt (Y/N)

Occupation

LAFARGE AGGREGATES & CONCRETE INDIA PVT. LTD.

Equinox Business Park (Peninsula Techno Park),
Tower-3, East Wing, 4th floor, Off Bandra - Kurla Complex,
LBS Marg, Kurla (West), Mumbai-400070, India

Name of
School/College
University

EDUCATION DETAILS
(To state qualification details starting from SSC till post graduation)
No. of
Period Attended
Class/Grade attempt
Major Subjects
Obtained
s
From
To
Made

TECHNICAL COURSES COMPLETED

Name of the
Course

Duratio
n

Year of
Passing

Marks %

Name and Location

of the Institution

PERVIOUS EXPERIENCE
(Starting from present employment)

Name
Present/Previous
employer/s

Period
Locatio
n

From

To

Current/
Last
Position
held

Total
CTC
drawn
Annually

Reasons for
leaving

TECHNICAL/ BEHAVIOURAL TRAINING ATTENDED

Period
Subject/Topic
INSTITUTE
From
To

LAFARGE AGGREGATES & CONCRETE INDIA PVT. LTD.

Equinox Business Park (Peninsula Techno Park),
Tower-3, East Wing, 4th floor, Off Bandra - Kurla Complex,
LBS Marg, Kurla (West), Mumbai-400070, India

Do you suffer from any health or physical ailment? (Please select

the appropriate box)

No
Yes , If Yes then please give
details:_____________________________
State any serious illness / hospitalization you have had during last 3 years:
Were you ever involved in any civil/criminal litigation? If so, give details:
References (exclude relatives) : give name, address, tel. no. and status:
1)
2)
Are any of your relatives employed or /associated with us? if so give details:
Have you been interviewed for employment in our organization before? If so
when and for which Position?
I understand that my employment is subject to the successful completion of a
physical examination by Company recommended Doctor and the careful
investigation of my record and references.
I affirm that the above facts in the application are true and that I will be liable
for dismissal from the Companys service in case anything mentioned above is
found to be incorrect or false or suppresses material information at any later
date.

_______________________
Date:
applicant

Signature of the

(If space is not sufficient against any item details may be given in separate enclosures.)

LAFARGE AGGREGATES & CONCRETE INDIA PVT. LTD.

Equinox Business Park (Peninsula Techno Park),
Tower-3, East Wing, 4th floor, Off Bandra - Kurla Complex,
LBS Marg, Kurla (West), Mumbai-400070, India