Application Number: 2

Name of the Post: General Manager (Works)

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Application Fee Details

Transaction ID: Transaction Date (DD/MM/YYYY): //

Fee Amount: Rs. /-

PERSONAL DATA

Name in Full: Purushottam Roy

Father's / Husband's Name: Late Chanchal Roy

Present Postal Address: Indian Dress House Jessore Road Habra - 743263

Permanent Address: 27 A Ultadanga Road, Shyambazar, Kolkata-700004

Telephone No.: Office: Resi:

Mobile No.: 9038510247

Fax No.:

Email: purushottamroy077@gmail.com

Date of Birth (DD/MM/YYYY): 17/12/1997 Age: 23 Years

Category: SC

Nationality: Indian

Religion: Hindu

Whether Released RCO/ECO/SSCO: No

Last Rank:

Gender: Male

Marital Status: Single

Health Fitness: Heights: 176 CMs Weight: 80 KGs Chest: CMs

 ACADEMIC & PROFESSIONAL QUALIFICATIONS

Details of Academic & Professional Qualifications (Latest qualification onwards)

(Also mention details of statutory qualifications, if any, required for the post)
Examination / Year of Year of Leaving / Board / % of Marks
College / Institution Remarks
Degree Passed Joining Passing University Obtained
B.E Sathyabama Institution of 2016 2020 Sathyabama 75 Good
Science and Technology University
HSC Kalyani Public School 2014 2016 C.B.S.E 70 Good
10 Don Bosco School 2003 2014 I.C.S.E 68 Good

Computer operational knowledge: Yes If yes, level of knowledge: Basic

PARTICULARS OF EXPERIENCE

Total Experience: 0 Years 0 Months

Details of experience starting from present position

Employer's Name & From To Duration Designation & Basic Total Exact Nature of Reason for
Complete Address Date Date (Yrs+Mths) Scale of Pay Pay Emoluments Duties Leaving
- - - - - - - - -

GENERAL INFORMATION

Salary Details of Present Position held (As on Date of the Application)

Scale of Basic Spl. Pay House Rent Any other Cash Gross Earnings per
DA CCA
Pay Pay Allowance Allowance Allowance Month

If retired from Govt. / Defence Services, give details of pension / equivalent of Pensionary benefits:

Minimum time required to Join, if selected: 1 month

Have you been an applicant for any post in this Company before? No

Have you ever been arrested in a criminal case or convicted, fined or imprisoned for No
violation of any law (excluding minor traffic violation) or is any disciplinary / vigilance case
pending /ever instituted against you or have you been barred /disqualified by a Public
Service Commission university or any other educational authority from appearing in its
exam.:

Is any of your relatives employed in HSL / SSL ? Or are you related to any of the Directors of the HSL ? if yes, please give the
following details:
His / Her Name Relationship Occupation Where Employed

Have you ever been abroad ? if so give following particulars:

Country Visited Date of Arrival Date of Departure Duration of Stay Purpose of Visit

EXTRA CURRICULAR ACTIVITIES:

Member of School football Team, 1 year of Basketball and Table Tennis in School, Swimmer

References: (These persons should be resident in India and holders of responsible positions and they should be intimately
acquainted with applicant's character and work but must not be relations)
Name Address Occupation or Position

Any other relevant details / information not covered above, that you may wish to furnish, please send all your documents with this
print form.

I CERTIFY THAT:

The information furnished above is correct.

I am / am not employed in Govt. / Statutory Organisation / Public Sector Undertaking.
My application has / has not been forwarded through proper channel.
I am ready to join the Company after resigning the post / retaining protective lien on my present post in government / Public
Sector Undertaking.

Note: Delete whichever is in applicable.

Dated:_____________ Signature of Applicant

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