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Novartis Hyderabad
Job Application Form

Name:______________________________________________ 

Position Applied for:_____________________________ 

Novartis is an employer committed to equality of opportunity, fairness, work and lifestyle, mutual respect and dignity at work for all associates. This application form is intended only for candidates applying for career opportunities with Novartis Healthcare Pvt. Ltd., Hyderabad, India. The information contained herein is required for reasons of compliance with local laws, statutes and policies, and is completely confidential.

Confidential 

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/Ms. give details: Confidential      Page 2   ./Mrs.                                                                             PERSONAL INFORMATION Paste your recent colour photo First Name Mr. Date of Birth (DD/MM/YY) MiddleName Surname   Place of Birth: State: Country: Sex: Male Female Place of Work: Marital Status: Married Single Father / Spouse Name : Present Address: City State Pin Code Contact Numbers Mobile Landline Permanent Address: City State Pin Code Contact Numbers Mobile Landline E-mail ID: EDUCATION (Begin with the most recent qualification and end with Std Xth) Name of the course Specialization If any Name of Institute/University Location From Period To Marks (% or CGPA) Was there any break in your Education? If Yes.

) Any Other Monthly Payment Total Monthly Salary Do you have employee stock options? Yes / No If Yes. Course assignments. Technical training. your preferred location: Total Cost to Company Other benefits (Annual) Provident Fund Gratuity Superannuation Medical Reimbursement Retention Bonus / Skill Incentive (if any) Total Annual Salary Medical Insurance Expected Salary (p. Professional training etc) : List any papers published by you: Membership of recognized professional bodies: PRESENT EMPLOYMENT DETAILS: Name of Present Employer / Organization: Address: Designation: Employment Period: Current Role (In brief): From: Employee Code: To: Contact No: Notice Period: Awards received at work: Fixed Salary (A): Monthly break up Basic HRA Conveyance Allowance Special Allowance Variable Salary (B): Annual break up Variable Pay (Performance Linked) Ex-gratia / Bonus LTA Are you willing to be posted anywhere? Yes/No If no. please mention current value: Last Performance Review date : Performance Cycle Period : Confidential      Page 3   .                                                                             Scholarships and prizes won during the academic career:   Special Training if any (Project work.a.

                                                                             LAST EMPLOYMENT DETAILS: Name & Address of Employer Period Employed From / To Designation CTC Details   Reasons for leaving Awards received at work: Was there any break in your service? If yes. give details: REFERENCES: (please fill at least one of your previous supervisor details as reference) Reference (1) Reference (2) Name Company Current Designation Nature of Relationship Land line (with STD code) / Mobile: E-mail ID: How many years you have known him/her ABOUT YOURSELF: Reason for applying at Novartis: Have you worked with Novartis earlier? If yes. reasons for leaving) Confidential      Page 4   . please mention the details (Designation. period.

Name:____________________________ Place:___________________ Date:____________________ Signature of Applicant:_______________ Confidential      Page 5   . please detail: No If Yes. please detail: No If Yes. Passport Number : Valid upto : Have you attended selection Yes Process at Novartis before? Do you have any relative Employed with Novartis? Yes No If Yes. please detail: No If Yes.                                                                             Have you been referred by a Novartis employee? If Yes Name of Employee Employee Code   Line Function Have you been referred by a Placement Agency? Yes /No If Yes . I understand that any misrepresentation or suppression of material information will render me liable to be dismissed by the Company. please detail: Have you suffered from any Yes Major illness/surgery/ accident in the past five years. Yes prosecuted or convicted for any criminal offence? Any Disability? Yes No If Yes. Have you ever been arrested. Please Explain: DECLARATION I hereby certify that the facts stated by me in this application are true. I have no objection if you wish to verify my answers. please detail: Do you have any bond/commitment to another employer or organization that might affect your employment with us? Yes No If Yes. Name of the placement agency: ADDITIONAL DETAILS: Languages Known: Nationality: Do you hold a valid Passport? Indian Yes Others No Citizenship Status: If Yes.