JOINING FORM (E3)

F : HR :18
CONTINENTAL CARBON INDIA LIMITED
A-14, Industrial Area No.-1, South Side of G.T. Road,
Ghaziabad- 201001 (U.P.)

PERSONAL HISTORY FORM

AFFIX A RECENT
POSITION APPLIED : PHOTOGRAPH

PERSONAL DETAILS:

1. FULL NAME :
2. DATE OF BIRTH : PLACE OF BIRTH
3. PRESENT MAILING ADDRESS :

TELEPHONE NO. MOBILE NO.

4. PERMANENT ADDRESS :

TELEPHONE NO.

5. MARITAL STATUS SINGLE/ MARRIED SUB CASTE *

6. BLOOD GROUP : E- MAIL

7. HISTORY OF ANY KNOWN DISEASE :

Disease Period

8. FAMILY BACKGROUND :

NAME EDUCATION OCCUPATION D.O.B. AGE

a) Father

b) Mother

c) Spouse

d) Children

e) Brothers

f) Sisters

9. EDUCATIONAL QUALIFICATION: (Starting from SSC)

S.NO. EXAM PASSED YEAR OF PASSING UNIVERSITY/ BOARD MAIN SUBJECTS CLASS OBTAINED

a)

b)

c)

d)
e)
f)
f)
g)
* You may choose not to mention this information
Date of Issue 01/01/08 Rev. 01 Date of Rev 07/07/09 Continental Carbon India Limited

10. ANY SPECIAL TRAINING/ ASSIGNMENT DONE

11. DETAILS OF WORK EXPERIENCE *

Please record your experience details in chronological order starting from present employement:

NAME AND NATURE OF SALARY

DATE ADDRESS OF EMPLOYER'S NET.
FROM TO EMPLOYER BUSINESS DESIGNATION DUTIES (RS.) REASON FOR LEAVING

* Use additional sheets if required

12. GIVE TWO REFERENCES (NON RELATIONS) WHOM WE CAN REFER FOR VERIFICATION:

NAME POSITION HELD ADDRESS AND MOBILE NUMBER

OTHER INFORMATION

How much notice period would you require to join:

Additional Remark (any special qualification, experience, achievements)

Leisure Interests *

* You may choose not to mention this information

DECLARATION
I certify that the foregoing information is correct and complete to the best of my knowledge and nothing has been concealed/
distorted. At any time, if I am found to have concealed/ distorted any matter/ information, my appointment shall be liable to
termination without any notice or compensation.

Place:

Date: Signature

FOR OFFICE USE ONLY

Interview notes and decision taken

Date Signature of Department Head Sign of Chief of HRD Managing Director

Date of Issue 01/01/08 Rev. 01 Date of Rev 07/07/09 Continental Carbon India Limited
13. COMPENSATION DETAILS

HEAD PRESENT EXPECTED PROPOSED

Basic Salary

Dearness Allowance

Fixed D.A. (if any)

House Rent Allowance

Conveyance Allowance/ Petrol Expense

Education Allowance

Canteen/ Lunch Expenses

Bonus/ Ex gratia (per annum)

LTA P.A./P.M.

Medical Reimbursement (maximum Limit)

P.A./P.M.

Uniform Allowance

Superannuation

Provident Fund

Group Life/ Accident Insurance Policy Coverage

GROSS SALARY P.M.

14. Provident Fund No. (if any)

15. Do you have superannuation scheme? ( ) Yes ( ) No

If yes what is yearly contribution

Signature of Applicant

Date of Issue 01/01/08 Rev. 01 Date of Rev 07/07/09 Continental Carbon India Limited