PES&Ts,

SHAIKH GROUP OF INSTITUTIONS,

PLEASE AFFIX
COLOUR
PASSPORT SIZE
PHOTOGRAPH
HERE

SHAIKH CAMPUS, NEHRU NAGAR, BELGAUM 590 010.

Tel: 0831-2473253 Fax: 0831-2473127
Email: recruitment@sgibgm.org Web: www.pestbgm.org

OFFICE USE

EMPLOYMENT APPLICATION FORM (To be filled in block letters only)

Application
for the post of
Name of
Institution

Subject
teach

Recd.
Dt.

Not
suitable

Called for
interview

Interview
result

Put in
active file

Scrapped

PERSONAL DATA
FULL NAME :
CELL No.

EMAIL

CELL No.

EMAIL

FATHERs/
HUSBANDs NAME :
ADDRESS FOR COMMUNICATION WITH PIN CODE:
PH. No. WITH STD CODE :
PERMANENT ADDRESS
WITH PIN CODE:
PH. No. WITH STD CODE :
DATE OF BIRTH
/

PLACE OF BIRTH

NATIONALITY

MARITAL STATUS

DETAILS OF CHILDREN

No.

SEX

AGE

1.
PAN No.

ADHAR No.

BLOOD GROUP

2.
3.

EDUCATION : (Give details starting from SSLC)

EXAM
PASSED

YEAR OF
PASSING

SCHOOL/COLLEGE/UNIVERSITY

3X MAIN
SUBJECTS

MEDIUM

% OF
MARKS (*)

NOTE: (*) To be supported by Notarized documents

How do you rate your English language ability?
WRITTEN

EXCELLENT

GOOD

FAIR

POOR

SPOKEN

EXCELLENT

Are you Computer literate? If yes give details :

PC/Laptop at home: YES/NO

Internet at home : YES/NO

GOOD

FAIR

POOR

LANGUAGES KNOWN (PUT )

FAMILY BACKGROUND
Qualification

Occupation

Monthly
income/mth

Language

Understand

Speaks

Read

Write

Father
Mother
Husband/Wife
Brother
Sister (s)

EMPLOYMENT RECORD (Ascending order)

Date of
Joining
DD/MM/YY

Leaving
DD/MM/YY

Name & Address of

organization

Position in
organisation

Main Duties &

responsibilities

Mention two significant contributions / improvements

accomplished by you in your previous assignments:

Gross
Emolument in
Rs. pm (All
inclusive)

Reason for
leaving

Breakup of last salary drawn pm

(*)
Basic
DA
HRA
Medical
Conveyance
LTA
Bonus
Other

TOTAL:

Note: (*): Authenticated supporting documents to be attached

Mention Hobbies/ Music/ Sports you are proficient/interested in:

Are you in to consultation / private practice / Business?

If yes, give details and professional address: Yes / No :

Have you applied previously for any post at Shaikh Group of Institutions? Yes / No
If yes, give details :

Reference (Reference of people who will give details of professional track records)
(Do not give reference relatives and SGI associates)
Contact
Company /
Email ID
Address
Designation
No.
Name
No.
Firm

Would you like to be considered for any other job? Yes / No

If yes, mention for which other posts you would like to be considered :

How did you come to know about this vacancy? Name of the news paper/media :

Personal reference

Would you like to refer to your previous / present employers and your references at
this stage, if necessary? Yes / No
Gross Salary range acceptable: Rs.

/month

(e.g. min. Rs.5,000/- to Max. Rs. 5,500/-)

Joining time required :

days after receipt of appointment letter.

I hereby declare that the entries in this form are true to the best of my knowledge
and

belief.

understand

that

my

candidature

will

be

cancelled

if

any

of

the

information is found to be false or incorrect. Further, if selected, I will abide by

the rules and regulations of SGI and also the directions given to me from time to
time.

Date:
Place:

Signature of Applicant

MANDATORY NOTINGS (For use of selection committee Chairman / Members:

Job Knowledge / Skills :
English Language:
Computer Skills:
Attitude:
Personality:
Career Goals:
Learn-ability:
Subject Expertise (Teaching only)
Comments:

Fixed Salary:
Basic:
PBVA:
DA:
HRA:
AGP:
Others:
Total:
MGT PF:
G. Total:
Security Deposit:

Date of Joining:

Signature (HR-Head)

Signature with date of selection

Form Checked by & confirmed that all

committee Members:

certificates have been collected for

Name:

Signature with date

personal file on //
1.

Salary Certificate:

2.

Sign. of I/c recruitment:

3.

4.

5.

SGCS/EEC/FMT-169/15-16 Dt.4/3/16.