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Offered Date of
Designation in RIM Joining
Full Name (Block Letters)
Affix recent passport
Father’s / Husband’s Name size color Photograph
Date of Sex Nationality Height Weight Has worked or Interviewed
Birth & Age before by RIM

Marital Date of
Single Married
Status Anniversary

Name & Relationship of

Present Address Person to be informed in case
Permanent Address
of Emergency (3 contact No.

Ph: Ph: Ph:

Passport Number Driving License No.

Personal Email ID: 1.
Interviewed Date: Offered Date: Joined Date:
Interviewed by Technical Panel: 1.
Interviewed by H.R :

Approved by:

Academic & Professional Qualifications:

Institution / Class/ %
SL No Exam Passed Year of Passing Major Subjects
University Marks

Total Years of Experience: Relevant experience with respect to Job offered:

Name & Address of Designation Reason for
Sl. No From To CTC
Employer Leaving

Professional references from the previous Company

Official E- Mail Id &
Name of the Company Name of the Person Designation
Contact No

Languages Known (Underline mother tongue) Physical disability / Critical accidents / Critical diseases if any:

To read Provident Fund No.

To write Blood Group

Any foreign Language known
To speak
other than English
Key Technical skills:

Non Technical Skills:

Extra curricular activities:

Details of children (if Married ) & dependants:

Name Age Relationship Occupation

I Certify that the above information is correct and complete to the best of my knowledge and belief. If, at any time, I
am found to have concealed any material information or even false information, my appointment shall be liable for
summary termination without notice or compensation. I shall also abide by the rules and regulations of the
organization, which are in force from time to time.


Date: Signature

Note: All the information has to be mandatorily filled and signed by the employee.

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