APPLICATION FORM

APPLICANT NAME:
SUR NAME FIRST NAME MIDDLE NAME

CITY RESIDING IN:

POST APPLIED FOR:

CONTACT NUMBER:

EMAIL ID:

SOURCE:
o MANPOWER CONSULTANT

o EMPLOYEE REFERRAL

o WALK IN

o ADVERTISEMENT

o Other

AFFIX YOUR

PHOTOGRAPH HERE

This application form is important for the use of this selection process.

INSTRUCTIONS:
1. PLEASE ANSWER ALL QUESTIONS CAREFULLY AND COMPLETELY.
2. PLEASE DO NOT WRITE IN MARGINS.

1
IDENTIFICATION: (IN BLOCK LETTERS)
NAME SUR NAME: FIRST NAME: MIDDLE NAME:

ADDRESS: PRESENT: PERMANENT: TELEPHONE NOs:

CELL:

RESIDENCE:

OFFICE:

CATEGORY ☐SC/ST ☐OBC ☐GENERAL

MARITAL STATUS: CHIDREN AGES DEPENDENTS
MARRIED: ☐ NUMBER RELATIONSHIP
UNMARRIED: ☐
NAME OF SPOUSE & OCCUPATION

FATHER’S NAME IN FULL: FATHER’S PRESENT/

LAST OCCUPATION:
HUSBAND’S NAME IN FULL: HUSBANDS’S PRESENT/
LAST OCCUPATION:
NAMES OF RELATIVES/ACQUAINTANCES IN OUR EMPLOYMENT & THEIR RELEATIONSHIP WITH YOU:

WERE YOU IN OUR EMPLOYMENT AT ANY TIME PREVIOUSLY? IF YES, GIVE DETAILS.

WERE YOU EVER INTERVIEWED BY US? IF YES, GIVE DETAILS.

ACCOMODATION: RENT ☐ DO YOU HAVE A DRIVING LICENSE? YES ☐ NO ☐

OWN ☐ SPECIFY TYPE OF VEHICLE:
KNOWLEDGE OF LANGUAGES : (WRITE GOOD, FAIR, NOT AT ALL)
LANGUAGE
READ
WRITE
SPEAK
HEIGHT : CMS DO YOU HAVE ANY DIFFICULTY IN :
WEGIHT: KGS SPEECH HEARING SIGHT LIMBS
DO YOU WEAR GLASSES? YES ☐ NO ☐
IF YES, STATE OPTICAL LENSE NUMBER: LEFT RIGHT
ARE YOU WILLING TO BE EXAMINED BY OUR DOCTOR? YES ☐ NO ☐

STATE TIME LOST IN SICKNESS DURING LAST TWO YEAR.

EDUCATION / TRAINING MATRICULATION ONWARDS:

NOTE: ALL CERTIFICATES AND MARK SHEETS WILL HAVE TO BE SUBMITTED AT THE TIME OF JOINING, IF SELECTED.
DEGREE DIPLOMA SPECIALIZATION INSTITUTION SUBJECTS NO.OF.ATTE % MARKS,
CERTIFICATE WITH YEAR OF MPTS GRADE,
PASSING CLASS
1 S.S.C
S.S.L.C
2
2 H.S.C/I.C.SE
PUC/
PRE DEGREE

3 B.COM
B.SC
B.A/B.CS

4 DME, DEE,
DCE, ETC

5 B.E, B.TECH,
BSC-TECH,

6 MSC, M.TECH
MCOM,MBA
CA, ICWA

7 ADDITIONAL
QUALIFICATIONS
IF ANY

MEDIUM OF INSTRUCTION IN : SCHOOL COLLEGE:

SCHOLARSHIPS/ HONOURS RECEIVED:

PROFESSIONAL HONORS RECEIVED:

RESEARCH PAPERS/ PUBLICATIONS: USE SEPARATE SHEETS IF REQUIRED.

WHAT HAVE YOU DONE TO ADD TO YOUR EDUCATION/ KNOWLEDGE SINCE YOU LEFT COLLEGE?

STATE YOUR EXTRA-CURRICULAR ACTIVITIES/ HOBBIES/ SPECIAL INTERESTS:

3
EMPLYOMENT:
1. START WITH YOUR PRESENT EMPLOYER.
2. INCLUDE PERIOD OF EMPLOYMENT.
3. CONSIDER EACH PROMOTION A NEW JOB.
MONTH YEAR POSITION REPORTING TO EMPLOYER GROSS SALARY REASON FOR
DEPARTMENT NAME & IN INR LEAVING.
FROM TO PLACE OF ADDRESS
POSTING

PLEASE DRAW AN ORGANIZATION CHART OF YOUR LAST COMPANY, INDICATING CLEARLY ONE LEVEL ABOVE AND ONE LEVEL
BELOW YOUR OWN.

4
DO YOU HAVE ANY OBJECTION IF ANY REFERENCE IS MADE TO YOUR PRESENT / PAST EMPLOYER?

WERE YOU EVER BONDED? YES ☐ NO ☐

EXPLANATION FOR UNEMPLOYMENT:

BREAKUP OF LAST SALARY IN INR:

MONTHLY : ANNUAL :
BASIC SALARY BONUS/ EX-GRATIA
DEARNESS ALLOWANCE MEDICAL BENEFITS
HOUSE RENT ALLOWANCE LTA
CITY ALLOWANCE OTHERS
CONVEYANCE ALLOWANCE RATE OF PROVIDENT
FUND
OTHER ALLOWANCE RATE OF GRATUITY
RATE OF SUPERANNUITY
OTHERS IF ANY.
TOTAL MONTHLY EMOLUMENTS: INR
(NOTE: PAYSLIP IN SUPPORT OF ABOVE FIGURES WILL HAVE TO BE SUBMITTED)
P.F.ACCOUNT NO:
FAMILY PENSION SCHEME ACCOUNT NO:
WHAT REMUNERATION DO YOU EXPECT?
DO YOU HAVE ANYOTHER INCOME BESIDES WHAT YOU RECEIVE FROM US? YES ☐ NO ☐
ARE YOU WILLING TO WORK:
ON PROBATION: YES ☐ NO ☐ JOB REQUIRING FREQUENT TRAVEL: YES ☐ NO ☐
IN SHIFTS: YES ☐ NO ☐ IN ANY PART OF INDIA: YES ☐ NO ☐
IF APPROVED, HOW SOON CAN YOU JOIN US?

(NOTE: A RELIEVING LETTER ALONG WITH YOUR EXPERIENCE AND SALARY CERTIFICATE WILL HAVE TO BE SUBMITTED, IF SELECTED).
FOR TECHNICAL AND PROFESSIONAL PERSONNEL ONLY:
SPECIALIZED TRAINING IN ENGINEERING/ TECHNOLOGY/ PROFESSIONAL SPECIALIZATION:

YOUR FAVORITE ENGINEERING/ TECHNOLOGY/ SPECIALIZATION SUBJECTS:

BRANCH OF ENGINEERING/ TECHNOLOGY/ SPECIALIZATION YOU HAVE A PREFERENCE FOR:

ARE YOU PURSUING ANY PART-TIME / FULL TIME COURSES:

PLANS FOR FUTURE STUDIES:

5
STATE BRIEFLY, WHY YOU THINK YOU WILL BE SUITABLE FOR THIS POSITION.

REFERENCES:
GIVE NAMES OF THREE PERSONS, OTHER THAN RELATIVES KNOWN TO YOU FOR LAST THREE YEARS. (PREFERABLY
ONE FROM YOUR TEACHERS/PROFESSORS).
SR NO. NAME BUSINESS ADDRESS AND TELEPHONE

I DECLARE THAT ALL THE STATEMENTS MADE & FIGURES STATED ABOVE BY ME IN THIS FORM ARE CORRECT AND
THAT MY ANSWER SHALL FORM THE BASIS OF MY EMPLOYMENT WITH THE COMPANY.

DATE: SIGNATURE OF APPLICANT:

FOR OFFICE USE ONLY:

FIRST INTERVIEW DATE INTERVIEWED BY:
COMMENTS AND SIGNATURES:

FINAL INTERVIEW DATE INTERVIEWED BY:

COMMNTS AND SIGNATURES:

SELECTION APPROVED BY HR:

OFFER DETAILS GRADE DESIGNATION

PLACEMENT DIVISION REPORTING TO

JOINING DATE

REMARKS:

SIGNATURE: