Thirumalai Chemicals Limited

APPLICATION FORM
PERSONAL PROFILE Photograph

NAME

APPLICATION FOR THE POST OF: LOCATION: ADDRESS FOR COMMUNICATION:

PERMANENT ADDRESS

Phone : Date of Birth: Nationality: Native Place: FAMILY DETAILS S.No Name

Mobile: Age:

E- mail: Place of Birth: Marital Status: Single / Married Date of Marriage:

Age

Relationship

Occupation

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Thirumalai Chemicals Limited

ACADEMICS:
PERIOD FROM TO COLLEGE/ UNIVERSITY/SCHOOL % OF MARKS

DEGREE

SPECIALISATION

CLASS

ACADEMIC ACHIEVEMENTS: a) Prizes / Scholarship / Award won

b) What factors contributed to your academic achievements?

SPECIALISED TRAINING/ON-THE-JOB TRAINING UNDERGONE: Please do not mention routine courses. COURSE PERIOD / DURATION INSTITUTION

CAREER OBJECTIVES: a. What made you take up your present profession and what would you define as your career Objective/s? b. In what way do you think TCL meets your career objectives?

c. What kind of work gives you satisfaction and what kind of professional values do you Appreciate? HRD Page 2

Thirumalai Chemicals Limited

HOBBIES: a. WHAT LEISURE TIME ACTIVITIES DO YOU PURSUE AND HOW DID YOU DEVELOP AN INTEREST IN THOSE? b. HOW DO THESE BENEFIT YOU?

EMPLOYMENT DETAILS (Please begin with current job) PERIOD EMPLOYER / Name of Organization Designation Reason for Leaving

FROM

TO

Total Years of Experience : (YY-MM) Please draw the relevant part of your Organisation Chart to specify the reporting relationship between you, your superiors and subordinates on Page 7
LANGUAGES PROFICIENCY: Please indicate proficiency level (Good, Average, Poor) LANGUAGES KNOWN 1) 2) 3) SPEAK READ WRITE

MISCELLANEOUS:

Do you have any relative / friend working with our Group Company/UPL/CMC/LDS/LTS? If yes, kindly state name, designation and company:

Yes

No

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Thirumalai Chemicals Limited

Any other information that you may like to provide: Do you own a 2-wheeler / 4-wheeler with valid Driving license? Yes No

Notice Period for Experience Candidate: ___________________________ Are you ready to shift the family? Family Shifting Time Required: Passport status (Tick) If Passport is available: ___________________________ ___________________________ : Applied / Available / Not Available / Expired : Passport No:

Name Address & Phone No.s of two professional references other than relatives or friends
1) Name : Position : Company Name & Address: 2)Name : Position : Company Name & Address:

Email id : Phone No :

Email id : Phone No : DETAILS OF COMPENSATION:

Present: Particulars Salary + Monetary Perquisites (Rs.) Non-Monetary Benefits / Perquisites

Per Annum

Expected: Particulars Per Annum Salary + Monetary Perquisites (Rs.) Non-Monetary Benefits / Perquisites

Time / Days required joining in case selected: The Information given by me is true to the best of my knowledge.
DATE: HRD PLACE: SIGNATURE: Page 4

Thirumalai Chemicals Limited

(A) ADDITIONAL INFORMATION REQUIRED IN APPLICATION FORM Full Name:
(In Block Letters)

Fathers / Husbands Name: Phone: Religion: Identification Mark: Height: Guardians Name 1. Do you have any physical disability? If any, Give Details. .. 2. Have you ever been convicted by a Court of Law or is any Criminal / Civil suit pending against you in the court? ..................................................................................................................................................................... 3. Have you ever been employed by TCL earlier? If yes, Department, period and Designation. 4. Have you ever applied, been interviewed in any of the member Group concerns (UPL/CMC/LDS/LTS) of our organization? If yes, give details. 5. Are you a member of PF / Superannuation / ESI (Give No.) . 6. Name & Address of next of Kin (Who should be contacted in case of emergency.) 7. Do you belong to any political party? If yes, give details of membership. Cm. Weight Age: Caste: Complexion: Kg. Blood Group

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Thirumalai Chemicals Limited

RELATIONSHIP DECLARATION
Date I.S/o Shri. here by declare that:

(1) Mr. who is working in .department at .is related to me as . (2) None of the employee (s) of this plant or any other our Group Companies (TCL/CMC/UPL/LDS/LTS) is related to me.

The above information is true to the best of my knowledge and if above information is false I shall be liable for severe disciplinary action by the company. Permanent Address: (Name & Address) .. .. .................... .. Signature.. Name Position Applied For ........

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Thirumalai Chemicals Limited

ORGANIZATIONAL CHART Please give your present companys Organisation Chart showing your position, reporting authority, persons reporting to you.

Please mention Brief description of present responsibilities in your current organization: (Technical Experience) and also give details of areas / equipment you consider yourself a specialist / field of interest.

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Thirumalai Chemicals Limited

INTERVIEW ASSESSMENT SHEET Name of the Candidate:.

Personality Attitude

Excellent

Good

Average

Poor

Positive Job/Conceptual Knowledge Excellent Inter-Personal Skills Excellent Leadership Skills Excellent Good Good Good

Negative Average Average Average Poor Poor Poor

Interviewers Assessment:

Recommended for employment: If yes, proposed designation & recommended salary : Interviewers : ___________________ Signature/s : ___________________ Date :
Medical Test Date : Position : Bond Period :

Yes

No

_________________ ________________ _________________ ________________

Fit / Unfit Cadre :

Department Selected for : Training : Yes / No Cerficates / Passport : Training Period :

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Thirumalai Chemicals Limited

REMUNERATION DETAILS WITH PRESENT EMPLOYER

DETAILES OF EMOLUMENTS Basic Pay / Stipend HRA / Living Allowance Special Allowance as per Cadre Fitment Allowance Medical Allowance (%) Service Allowance Conveyance Allowance City Compensatory Allowance (%) HOD Allowance Mobile Allowance Telephone Allowance LTA (%) ESI Contribution (%) PF Contribution (%) Gratuity (%) LIC Superannuation (%) Bonus Annual Performance / Incentive / Exgratia Any Other Allowance

PER MONTH (Rs.)

PROPOSED

(a) (b) (c) (d) (e) (f)

Total Rupees Note: Details declared above shall have to be satisfied with proof on joining.

Expected Gross Salary:

(SIGNATURE)

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