Page 1 of 5

APPLICATION FOR THE EMPLOYMENT

(To be filled in by Applicant in his / her own handwriting)
POSITION APPLIED FOR :
Affix Recent PassportSize Photograph

1. PERSONAL DATA
FULL NAME IN BLOCK LETTERS :
Dr./Mr./Mrs./Miss = MR MOHAMED EBRAHIM.A
(First Name)

(Middle Name)

Own House / Rented House (Please tick

appropriately)

Own House / Rented House(Please tick

appropriately)

ADDRESS
Present :
Dr/no 24 , narashimapuram 2nd cross street ,

(Surname)

Permanent:
2/426, poonganagar 2nd cross street , zuzuwadi
checkpost, Hosur 635126

near maduvankarai bridge , guindy, Chennai

600028
Tel. No. _______________ Mobile No 9003386608
Tel. No. _______________ Mobile No 9003386608
E-mail : aebrahim.ece@gmail.com
Date of Birth:12-04-1991
Place of Birth:
State of Domicile:
PUDUKOTTAI (TN)
Height (Cms):176
Weight (Kg):65
Marital Status: Yes/No
PAN No.:

Blood Group : B+ve

Passport No.:L7006085

LANGUAGES
Read
Write
Speak
Mother Tongue: URDU

Other Languages 1 TAMIL

2 ENGLISH

3 HINDI

4 TELEGU

5 KANNADA

Hobbies & Interests:

Playing Pc games, surfing internet , and Cooking is my hobbies.
Photography, learning speaking languages, board designing is my interest .

Professional Scholarships, if any:

Till now i have not received any scholarships.

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2. FAMILY BACKGROUND
Name

Date of
Birth
24-03-1958
29-03-1962
03-02-1987

Father: MR ABDUL GAFFORE.I

Mother: MRS RAZIYA BEGUM.A
Husband/Wife: (spouse) -Brother(s):
1.MR MOHAMED RAFFI.A
2.
3.

Age

Occupation

57
52
27

EMPLOYEE IN ASHOK LEYLAND

HOME MAKER
WORKING IN FTI BANGLORE

Sister(s):
1.
2.
3.
Children:
1.
2.
3.

3. ACADEMIC RECORD
Examination
passed

Degree /
Diploma

Year
of
pass
ing

Board /
University

Name &
Location of
Institution

SSC / SSLC

SSLC

200
7

CBSE

HSC / PUC

HSC

200
9

STATE
BOARD

MAHARISHI
VIDYA
MANDIR
SSC ,
HOSUR.
MAHARISHI
VIDYA
MANDIR
HSS ,
HOSUR

Graduation:
1st Year
2nd Year
3rd Year
4th Year
Post
Graduation:
1st year
2nd year
Any Other
Technical
Qualification
s
1
2
3
5
Any other:

Principal
Subjects
/Area of
specializatio
n

Part
Time /Full
Time /
Distance
Education

%
Ma
rks

FULL TIME

62
%

FULL TIME

67
%

Grad
e/
Clas
s/
Divis
ion
1ST
CLA
SS
1ST
CLA
SS

Page 3 of 5

Please account for any break in education / year lost etc.

4. ARTICLESHIP / SUMMER TRAINING / SHORT COURSES

ATTENDED
Name & Address of
Employer / Institution
1. ASHOK LEYLAND
PVT LTD

Period

2. ISM

Nature & Purpose

From
2-04-2007

To
12-04-2007

AUGUST 2013

JANUARY 2014

PERSONALITY
DEVELOPMENT CLASS.
ADVANCE DIPLOMA IN
EMBEDDED SYSTEMS.

5. CURRENT EMPLOYMENT

Emoluments (Calculate pm)

Name & Address

of employer :
Designation :
Salary
Basic ..
DA..
HRA .
Conveyance
Incentives..
Any other
(specify).
Total
Perks
Medical
LTA .
PF.
Bonus ..
Gratuity .

Date of joining:
Reporting to:
15000

No. of Subordinates :

Organisational Chart
(Draw a brief schematic diagram indicating your position in
relation to your department and indicate only one level of
subordinate relationship & two level of superior relationship)

Personal
accident
Insurance (premium paid
by company)

Any other

(specify)..
Grand Total
Responsibilities (use additional sheets, if necessary) giving details of area of expertise:

Reason for seeking change:

Minimum salary expected (all
inclusive):
Joining time required:

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Preference for location of work (if
any) :

6. PREVIOUS EMPLOYMENT HISTORY

1.

2.

3.

(Starting with the latest employment)

Name and address of Employer:

From:

Designation:
Responsibilities:

Reporting to:
(Name & Designation)

No. of Subordinates:
Reason for leaving:
Name and address of Employer:

Emoluments drawn :

Designation:
Responsibilities:

Reporting to:
(Name & Designation)

No. of Subordinates:
Reason for leaving:
Name and address of Employer:

Emoluments drawn :

Designation:
Responsibilities:

Reporting to:
(Name & Designation)

No. of Subordinates:
Reason for leaving:

Emoluments drawn :

7. OTHER PARTICULARS
1

Names of Persons known to you in any of our Group

Companies, if any

Have you ever applied to any of our Group

Companies? If yes, give details

Do you have any location preferences/Constraints? If

any, give reasons

What are your salary expectations?

If selected, how much notice would you require to

join?

From:

From:

To:

To:

To:

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Reference of two responsible persons not related to you
Name

Occupation

(Atleast one referee should be one of the ex-bosses)

Telephone No.

Address

Any other information you would like to furnish in support of your candidature:

DECLARATION:
I certify that the statements made by me above are true, complete and correct. I agree that in case
the Company finds at any time that the information give by me in this application is not true, correct
or complete, the Company will have the right to terminate my appointment without notice or
compensation at any time.
Date: .
Place:..

Signature..

8. FOR COMPANY USE

PRELIMANY INTERVIEW
Remarks:

Date:

FINAL INTERVIEW
Remarks:

Outcome:

Name (s) & Signature (s) of Interviewer

Date:

Outcome:

Name (s) & Signature (s) of Interviewer