CHEMICALS PVT. LTD.

APPLICATION FORM
AN ISO 9001, ISO (EMS) 14001 & OHSAS 18001 CO.

Post Applied For : Location :

Affix
Name : Passport Size
Photo

Father / Husband's Name :

Full Postal Address :
Present Address : Permanent Address :

Pin Code : Pin Code :

Tel. : Mobile : Email :

DOB : Marital Status : Unmarried Divorcee Married Children

Languages Known :

Read : Write : Speak : Understand :

REFERENCES

Name Address with Telephone Relationship Known for years

QUALIFICATION

Degree University Subjects Year %

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OTHER TRAINING / COURSES ATTENDED

Course Period Institute Number of Audits

Computer Knowledge

EXPERIENCE

Period Organization Designation Responsibility

Present Salary Expected Salary Joining Period

PERSONAL DETAILS

Height in cm Weight in kgs Blood Group

Have you been operated in last 3 years ? If yes, please give details

Do you need to take any medicines on daily basis ? If yes, please give details

Any known ailments which prohibits you from carrying out your professional work ? please give details

Which vehicle you have and can drive

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FAMILY DETAILS (FIRST NAME SHALL BE CONSIDERED AS NOMINEE)

Relationship Name Age Occupation Dependent ?

I hereby declare that all information given above is correct to best of my knowledge. I am
responsible for informing the firm of any change in the above information.

Sign. : Date :

Name :

I will submit necessary documents on joining :-

(1) Passport size photographs.
(2) Address proof (Ration Card / Driving License / Light Bill / Tel. Bill / Electorate ID Card).
(3) Copy of academic certificates / mark sheets.
(4) Copy relieving letter from immediate last employer.
(5) Copy of experience certificate.
(6) Signed Confidentiality & Non disclosure Agreement.
(7) Copy of PAN Card.

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 FOR OFFICE USE ONLY

INTERVIEW DETAILS

Date Post Considered Location

COMMENTS
Interviewer

Personality

Qualification Related

Technical Knowledge

Experience Related

Other

CONCLUSION Selected Short Listed On Hold Rejected

Name : Date : Sign :

ACCOUNTS

Date of Joining Designation

Salary Details Department

Location

Other Comments

Reporting to

Director Approval HR record updated Date :

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