DN-32, Sec.

-V, Salt Lake City, Kolkata-700091

Job Application cum Declaration

Paste your
1. Name:______________________________ Nick Name:___________________ recent passport
size photograph
2. Father’s name:___________________
here and sign
3. Permanent Address (With contact numbers):_______________________________________ through

_____________________________________________________________________________

4. Present Address (With Landmark): _______________________________________________

_____________________________________________________________________________

5. Date Of Birth:____________________________________ Age as on date:_______________________

6. Nationality: _____________________________________

7. Voter Card Number: _____________________ Aadhar Card Number: ___________________________

8. PAN Number: ____________________________________

9. Marital Status: ___________________________________

10. Contact No (Residence):__________________ Contact No (Mobile/ Handphone):_________________

11. E-mail address: _______________________________________________________________________

12. Educational Qualification:

Grade/ Percentage
Type of Examination Year of passing Name of Institution/University
Division Obtained

12. Work Experience (if any):

Name of the Organization From To
(Starting with the Present Functional Internal HR
Sr. No Posted at
Employer) (Date) (Date) Role Grade / Band

(Please use separate sheet if required)

13. Have you been referred by any Bandhan employee? Yes No

If Yes, then please share, Employee Name :______________________ Emp. No. : ________ Mobile No. : ____________

14. Have you appeared in any interviews Yes No If Yes, when :____________
in Bandhan earlier?

15. Have you been subjected to any

Disciplinary Proceedings by your previous Yes No
Employer(s) at any time?
If yes, please give a brief description of the case(s) and whether you were punished or exonerated in a separate sheet.

16. Have you ever been proceeded against Yes No

Under any Criminal, Civil statutes?

If yes, please give a brief description of the case(s) and whether you were punished or exonerated in a separate sheet.

17. Do you have any relative working in Bandhan? If yes, please provide the name and the relationship:

1. __________________________________ 2. __________________________________

18. Please submit details of 2 referees acceptable to Bandhan:

1. Name : ____________________________________ 2. Name : ____________________________________

Designation : _______________________________ Designation : _______________________________

Organization: ______________________________ Organization: _______________________________

Office Address: _____________________________ Office Address: _____________________________

__________________________________________ __________________________________________

__________________________________________ __________________________________________

Contact Number: ___________________________ Contact Number: ___________________________

I hereby declare that all statements made hereinabove are true, complete and correct and are not false or misleading.
I understand that in the event of any information so furnished being found false or incorrect or misleading, I may be
dismissed from the services of Bandhan (if selected) or may be proceeded against by Bandhan for giving false and incorrect
statements, under the appropriate law.

NAME : _______________________________ SIGNATURE : ______________________________

DATE : _______________________________ PLACE : _______________________________

For Office Use Only
Verified By:
Name : Code No:
Designation: Division/Cluster:
Comments from Verifier: