Campus Application Form

Reliance Industries Limited – GET

Name PATEL URVITKUMAR ATULBHAI

Roll No. 190130117101

Date of Interview 8-DEC-2022

Qualification B.E Discipline I.C

Name of Institute G.E.C-SEC-28 GANDHINAGAR

Personal Information

First Name
URVITKUMAR
Middle Name
ATULBHAI PHOTOGRAPH
TO BE AFFIXED
Last Name
PATEL
Date of Birth 07 07 2 00 2 Age: 20 Sex: Male Female

Marital Status SINGLE

Birthplace MAHESANA Blood Group O+
Nationality INDIA Identification Mark

Mobile No. 9313915737 Emergency No. & relation with the person 9825711583
Email ID Residence No.

Facebook ID Twitter ID

(Aadhaar Card number is mandatory. In case you don't

Aadhaar Card no
have, kindly obtain the same before your joining)

Present Address

Permanent Address

Family Details

Name Contact No. Qualification Profession Location

Father

Mother

Sibling (1)

Sibling (2)

Sibling (3)
Qualification and Other Details

Qualification From To Institute / Board Grade / % Specialization

(DD/MM/YY) (DD/MM/YY) / University

Graduation (BE /B.Tech)

Higher Secondary (12th)

/ Diploma

Matriculation (10th)

Other Courses /
Certification

Project Undertaken / Internship details (Starting from latest one)

Name of Organization Duration Project / Internship Title

(From MM/YY To MM/YY)

Have you earlier attended test / interviews held by Reliance Industries Ltd.? Yes No

If Yes, When (Date), Position

Are any of your relative(s) currently employed with Reliance Group? Yes No

If yes, Name , Position , Location

3
Help us know you better
1. Where do you see your professional career in the next 2-3 years?

2. What do you like to do in your free time?

3. What are your Strengths & Areas of Improvement? (Mention two)

Strengths Areas of Improvement

4. How will you describe your personality?

5. Who is your role model? Briefly explain why?

6. Your achievements (Academic & Extra Curricular)

Date Signature of the candidate

Disclaimer - I hereby declare that the foregoing statements are true to the best of my knowledge. If at a future date, it is found that any of the information 4
herein is false or incorrect, the company will have the right to terminate my service without any notice or salary in lieu thereof
 PASTE YOUR
RECENT PASSPORT
SIZE PHOTOGRAPH
(Prospective employee should fill in Section 1 to 4 (Attested by the
The Examining Medical Officer will fill in Section 5 to 6 Examiner)
All details given below will be treated as confidential
Please Mark Where Applicable)

1 PERSONAL DETAILS:

First Name Middle Name Surname

_______________________________________________________________________________________________________
Address: ________________________________________________________________________________________________
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
City ________________________________________________________ Pin:________________________________________
Birth Place: ______________________________ Birth Date___________________________ Religion ____________________
(dd/mm/yyyy)
For post applied ___________________________ Marital Status: Married / Unmarried Sex: M / F

2 FAMILY HISTORY:
Has any one of your family suffered from

IF LIVING IF DEAD

AGE HEALTH (GOOD, BAD, FAIR) AGE AT DEATH CAUSE OF DEATH

FATHER

MOTHER

BROTHER (NO.)

SISTER (NO.)

HUSBAND/WIFE

CHILDREN (NO.)

3 PERSONAL HISTORY: Yes No

Are you in good health and capable of full work
Have you ever suffered from an occupational disease or injury?
Have you ever been discharged or rejected on medical grounds?
Types of Previous Occupation (Pl. describe in brief about company, nature of work, duration in years)
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
Name of Candidate: ______________________________________________
Have you taken any vaccination? Yes / No (If yes complete / partial) _____________________
Have you ever suffered from any of the following (Answer Yes or No. if yes, give details)

__________________________________________________________________________________________________________

(For female candidates only) Are you pregnant at present? Y / N Date of L.M.P. ___________

4 I declare that the above statements are true and complete to the best of my knowledge and belief and I agree that the results of
this medical examination in general terms may be revealed to the company if required. I also fully understand that in case I am
declared medically unfit due to any reason, I shall not be entitled for the employment in the company. However, the decision taken by
the company's doctor/s about my medical fitness will be final and binding to me.

Date (dd/mm/yyyy) Signature of Prospective Employee

5 RESULT OF PHYSICAL EXAMINATION:

(Examining doctor should ensure that candidate has filled up section 1 to 4)

1 General Appearance _________________________________________ Skin ___________________________________________
2Throat _________________________ Tonsils ___________________ Thyroid ____________________ Glands ________________
3 Ears _______________________ Hearing (e.g. Whisper at 2 meter)________________________ Nose ______________________
4 Teeth & Gums __________________________________________ Tongue _____________________________________________
5 Height _________ cms Weight __________ kgs Girth at Navel ____________ cms
BMI__________
Chest: Expiration ___________ cms Inspiration ___________ cms