Robert Bosch Engineering and Business Solutions Limited

Application for Employment

Position applied for

Location

Date
(dd/mm/yyyy)

(Recent Passport Size

Photograph To Be Affixed
During The Time Of
Interview)

General Instruction
Type or print this application form ; Specify all dates using DD/MM/YYYY format ; If
not hand written, sign at the bottom of each page
Personal Information

First Name

Middle Name

Date of birth (dd/mm/yyyy)

Gender

Last Name

E-Mail ID

Place of Birth: City & State

Change of Name if Applicable

Mother Tongue

Nationality

Religion

Date of Name
Change

(Former Name / Maiden Name )

Date of Issue
Valid till
Passport Number
Place of Issue
ECNR
(dd/mm/yyyy)
(dd/mm/yyyy)
Any ID issued by a competent Government or other agency? (Driving licence, passport, PAN card, Phone bill,
Bank passbook others) :
If yes, Please attach photocopy of anyone document.
Current Address
Door No.

Landmark
City

Residence phone with STD

Permanent Address :
Door No.

Landmark
City

House Name

State

Mobile
Number

Pin

Same as Above

House Name

State

Residence phone with STD

Domiciliary state

Family Information
Marital Status

Spouses Name - First

Number of children

Street

Street

Mobile
Number
Period of
stay

Middle

Pin

Date of Marriage (dd/mm/yyyy) :

Last
Occupation
No. of dependents
(Other than Spouse &

KG Campus, No.363, Thudiyalur Road, Saravanampatti, Coimbatore 641035, India

Telephone: +91 422 663 4000 Telefax : +91 422 663 4104
Registered Office : 123, Industrial Layout, Hosur Road, Koramangala, Bangalore 560 034, India

Robert Bosch Engineering and Business Solutions Limited

Fathers Name - First

Mothers Name - First

Children)

Last

Last

Middle

Middle

Occupation

Occupation

Education (Begin with the highest education qualification & end with class X; Attach legible photo copies of
Mark sheets / Degree Certificate / Provisional Degree Certificate)
Course /
Degree

Name of
Institute /
University

Location

Specializati
on

Year of passing
(Month / Year)
From

To

% of
Marks

Class /
Rank

Post
Graduation

Graduation

Diploma

Pre-University /
12th Std

School / 10th
Std

Others

Please provide additional information for Post Graduation

Post
Graduation

I SEM

II SEM

III SEM

IV SEM

V SEM

VI SEM

Aggregate

Percentage

Backlogs

Please provide additional information for Graduation

Graduation

I SEM

II SEM

III SEM

IV SEM

V SEM

VI SEM

VII SEM

VIII SEM

Aggregat
e

Percentage

Backlogs

Please provide additional information for Diploma

KG Campus, No.363, Thudiyalur Road, Saravanampatti, Coimbatore 641035, India

Telephone: +91 422 663 4000 Telefax : +91 422 663 4104
Registered Office : 123, Industrial Layout, Hosur Road, Koramangala, Bangalore 560 034, India

Robert Bosch Engineering and Business Solutions Limited

Diploma

I SEM

II SEM

III SEM

IV SEM

V SEM

VI SEM

Aggregate

Percentage

Backlogs

KG Campus, No.363, Thudiyalur Road, Saravanampatti, Coimbatore 641035, India

Telephone: +91 422 663 4000 Telefax : +91 422 663 4104
Registered Office : 123, Industrial Layout, Hosur Road, Koramangala, Bangalore 560 034, India

Robert Bosch Engineering and Business Solutions Limited

Professional Work Experience (Present / Last Employment)
Company
Name
Building
No.

Key job responsibilities

Street

Landmark

Cit
y

State

Pin

Employee ID
Current Designation &
Department
Date of joining

Reason for seeking change

Supervisors Name &
Designation
Supervisors Direct Number &
Mail Id
Type of employment

Last drawn salary

Are you under any bond?

If yes, specify bond period or amount / period
If No, then provide an alternate date to contact

Can the employer be

contacted now?
Reporting structure

Professional Work Experience (Past Employment)

1. Name of the company
Building
No.

Stree
t

Landmark

City

State

Pin

Key job responsibilities

Date of joining & Leaving

Duration of employment

Last drawn salary

Reason for seeking change

2. Name of the company

Building
No.

Stree
t

Landmark

City

State

Date of joining & Leaving

Duration of employment

Pin

Key job responsibilities

KG Campus, No.363, Thudiyalur Road, Saravanampatti, Coimbatore 641035, India

Telephone: +91 422 663 4000 Telefax : +91 422 663 4104
Registered Office : 123, Industrial Layout, Hosur Road, Koramangala, Bangalore 560 034, India

Last drawn salary

Robert Bosch Engineering and Business Solutions Limited

Reason for seeking change

Please use additional sheet (annexure I) if space is not sufficient.

Technical & Domain skills (List skills which relate to the position applied for & rate them as per
scale defined)
1 Basic Awareness; 2 End user; 3 Require guidance; 4 Can deliver independently; 5
Ability to train / guide others
Skill

Description

Self Evaluation

Training / Development Program / Certification (Specify date in dd/mm/yyyy format)

Program

Name & Location of

Institution

Details

From

To

REFERENCES
Details of persons under whom you have either worked or who know you professionally for at least 6 months
Name

Organization
&
Designation

Duration

Nature of
Associatio
n

E-Mail ID

Phone No. (With STD

Code)
Residence
Office

E-Mail ID

Phone No. (With STD

Code)
Residenc
Office
e

Details of friends / relatives employed in BOSCH

Name

Organization
&
Designation

Duration

Nature of
Associatio
n

KG Campus, No.363, Thudiyalur Road, Saravanampatti, Coimbatore 641035, India

Telephone: +91 422 663 4000 Telefax : +91 422 663 4104
Registered Office : 123, Industrial Layout, Hosur Road, Koramangala, Bangalore 560 034, India

Robert Bosch Engineering and Business Solutions Limited

KG Campus, No.363, Thudiyalur Road, Saravanampatti, Coimbatore 641035, India

Telephone: +91 422 663 4000 Telefax : +91 422 663 4104
Registered Office : 123, Industrial Layout, Hosur Road, Koramangala, Bangalore 560 034, India

Robert Bosch Engineering and Business Solutions Limited

Additional Details
Professional Achievement
Membership of
Professional
Association

Research Papers /
Articles published

Patents / License
Registered

Interests
Achievements in
Sports, Literary
activities etc.

Awards received

Hobbies & Special

Interests

Health
Height (Cm)

Weight (Kg)

Blood Group

Physical handicaps, if any, please provide

details

Have you suffered from any major illness / Surgery /

accident in the last five years?

If yes, please provide details

Chronic illness if any (high blood pressure, diabetes, etc)

Information on major surgical operations if any

Information on most recent illness, if any

Statutory Membership

Account Number

Are you a member of Employees Provident Fund Scheme

(EPF)?
Are you a member of Family Pension Scheme (EPS)?
Are you a member of Employees State Insurance Scheme
(ESI)?

Contact person in case of emergency (preferably local) :

Name
Door Number
House Name
Street
Landmark
City

State

Relationship

KG Campus, No.363, Thudiyalur Road, Saravanampatti, Coimbatore 641035, India

Telephone: +91 422 663 4000 Telefax : +91 422 663 4104
Registered Office : 123, Industrial Layout, Hosur Road, Koramangala, Bangalore 560 034, India

Pin

Robert Bosch Engineering and Business Solutions Limited

Residence
phone with
STD

Mobile Number

KG Campus, No.363, Thudiyalur Road, Saravanampatti, Coimbatore 641035, India

Telephone: +91 422 663 4000 Telefax : +91 422 663 4104
Registered Office : 123, Industrial Layout, Hosur Road, Koramangala, Bangalore 560 034, India

Robert Bosch Engineering and Business Solutions Limited

Language Proficiency
Language

Can Speak
Can Read
Can Write
Other Details
Have you been interviewed by Bosch before?

If yes, provide details (Division / Location / Month /

Year)

Have you ever been arrested, prosecuted or

convicted for any criminal offence, other than minor
traffic offences

If Yes, provide details

Social security no. / any ID no. issued by competent

Government office

If Yes, specify the details

Do you have any commitment to another employer

or organization that might affect your employment
with us?

If Yes, provide details

Any other information you would like us to know which may have significant bearing on our hiring decision?
If Yes, provide details

Certification by Candidate
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, the information provided by me in this application form is not correct, true or
complete, the company will have the right to withdraw, if selected, the letter of appointment before I join the
services or to terminate my appointment at any time without notice or compensation after I have taken up
service.

I authorize Robert Bosch Engineering & Business Solutions Ltd. or its agency to verify my
credentials. I will cooperate and facilitate the process of verification of my credentials / antecedents.

Name of the applicant

Date

Place

Signature

KG Campus, No.363, Thudiyalur Road, Saravanampatti, Coimbatore 641035, India

Telephone: +91 422 663 4000 Telefax : +91 422 663 4104
Registered Office : 123, Industrial Layout, Hosur Road, Koramangala, Bangalore 560 034, India

Robert Bosch Engineering and Business Solutions Limited

Remuneration Details : Annexure II

Please furnish your present remuneration
details.

Name:

Date of last salary revision:

Date of next salary revision:

Compensation Element

Amount (Rs.)

1. Cash components per month:

Remarks

Basic Salary

Dearness Allowance

House Rent Allowance

Conveyance Allowance

Childrens Education Allowance

Special Allowance

Other Perquisites

Gross Salary per month

2. Retirals:

PF

Gratuity

Superannuation

Total Per month

3. Cash components per annum:

Incentives

Bonus

LTA

Other Perquisites

Total

CTC ((1+2) X 12 +3 )

Deductions / Recoveries, if any

CTC Per Annum

Expected CTC Per Annum

I certify that the particulars furnished by me are correct.

Date :
Signature
Note: Please attach a copy of last drawn salary slip / other endorsement in support of the
KG Campus, No.363, Thudiyalur Road, Saravanampatti, Coimbatore 641035, India
Telephone: +91 422 663 4000 Telefax : +91 422 663 4104
Registered Office : 123, Industrial Layout, Hosur Road, Koramangala, Bangalore 560 034, India

10

Robert Bosch Engineering and Business Solutions Limited

above particulars.

Professional Work Experience (Annexure I)

3. Name of the company
Building
No.

Key job responsibilities

Stree
t

Landmark

City

State

Pin

Date of joining & Leaving

Duration of employment

Last drawn salary

Reason for seeking change

4. Name of the company

Building
No.

Key job responsibilities

Stree
t

Landmark

City

State

Pin

Date of joining & Leaving

Duration of employment

Last drawn salary

Reason for seeking change

5. Name of the company

Building
No.

Key job responsibilities

Stree
t

Landmark

City

State

Pin

Date of joining & Leaving

Duration of employment

Last drawn salary

Reason for seeking change

6. Name of the company

Building
No.

Key job responsibilities

Stree
t

Landmark

City

State

Pin

Date of joining & Leaving

Duration of employment

Last drawn salary

Reason for seeking change

KG Campus, No.363, Thudiyalur Road, Saravanampatti, Coimbatore 641035, India

Telephone: +91 422 663 4000 Telefax : +91 422 663 4104
Registered Office : 123, Industrial Layout, Hosur Road, Koramangala, Bangalore 560 034, India

11

Robert Bosch Engineering and Business Solutions Limited

Name:
Date:

KG Campus, No.363, Thudiyalur Road, Saravanampatti, Coimbatore 641035, India

Telephone: +91 422 663 4000 Telefax : +91 422 663 4104
Registered Office : 123, Industrial Layout, Hosur Road, Koramangala, Bangalore 560 034, India

Signature

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