IMS/47/01/FOR/11

Ed-01, Is-01, 15.08.2011

Ankit Mathur

SHREE CEMENT LTD.

Assistant Manager (HRD)| Shree Cement

Mob: +91 9251040309 | Email: mathurankit@shreecementltd.com

APPLICATION FOR EMPLOYMENT

CONFIDENTIAL
mathurankit@shreecementltd.com
I.

Ref. No.

Position

How did you come to know about this vacancy in SCL?

Job Sites
Newspaper advertisement
SCL website
Employment Exchange Reg. No. (if any)

SCL Employee
Placement Agency
Other

Photograph

PERSONAL DETAILS

II.
Name (In Block Letters-As stated in matriculation certificate)

(First Name)

(Middle Name)

(Last Name )

Father's/Husband's Name (In Block Letters)

Date of Birth

Marital Status

Gender

Age

Weight

Religion

Place of Birth

Height
metres/cms

Caste

Category SC/ST/OBC/Gen

Blood Group

Identity
Mark

Passport No.

Body Mass Index

(BMI)

PAN No.

Specify medical illness if any

including Color Blindness

Permanent Home Address

Present Residential Address

House No.

House No.

Apprt./Street

Apprt./Street

Locality

Locality

City/District

City/District

Pin Code

Pin Code

State

State

Contact No.

Contact No.

E-mail Id

Any relative/Known in Shree Cement Ltd.

Name of Relative

Yes /No _____

If yes , details

Department

Location

Relationship

IMS/47/01/FOR/11
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Languages Known
Language

I.

II.

III.

IV.

Speak
Read
Write

ACADEMIC DETAILS

III.
Year
Qualification

[FromTo]

Regular/Private/corr
espondence/parttime

Name of School/collage & Board/University

Passed at
% or CGPA which
attempt

Subject

*please indicate break in studies if any with reasons thereof

Membership of Professional Bodies / Institutes?

Name of Bodies/Institutes

Yes.

No
Membership No.

SKILL SET

IV.
Key Skill

Computer Knowledge

Hobbies
Achievement Summary (If Any):

Membership w.e.f.

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PRESENT EMPLOYMENT DETAILS

V.
I. PROFESSIONAL EXPERIENCE
Organization

Address

Nature of Business

Annual
Turnover

No. of employees
(in Group)

No. Of
employee

Date of Joining

Position on
joining

Current Position

Functional
Area

Total Experience
Organization Structure( Write Designation only )
His Superior

Your Superior(Reporting officer).

Your Colleague in dept

You

Your Colleague in dept

No. of employees reporting to you :

Key Responsibilities

Reason for seeking changes :

II. SALARY STRUCTURE (Per Month)-Presnt Employer
At time of
Joining

At time of
Joining

Presnt Structure

Basic/ Consolidated

Drivers
salary/Allowance

Conveyance
Allowance

Business Attire

Children Education
Allowance

Mediclaim/
Insurance

Medical
Reimbursement

L.T.A.

Entertainment
Allowance

Bonus

Dearness Allowances

P.F.

Uniform Maintenance

Superannuation

Soft Furnishing
Allowance

Gratuity

Books & Periodicals

Other Allowance

Any other facility:

Grand Total (All Above)

Expected Salary

Personal Pay

Joining Time Required

Special Allowance

Intensive/Variable pay
Gas/ Electricity
Allowance

Present
Structure

H.R.A./
Accommodation

IMS/47/01/FOR/11
Ed-01, Is-01, 15.08.2011
III. PROFESSIONAL EXPERIENCE (PAST)
Experience -1

Key Responsibility

Name & Address of Employer

Designation on Joining& leaving

Period (From -To)

Reason of Leaving

Last salary Drawn

Experience -2

Key Responsibility

Name & Address of Employer

Designation on Joining& leaving

Period (From -To)

Reason of Leaving

Last salary Drawn

Experience -3

Key Responsibility

Name & Address of Employer

Designation on Joining& leaving

Period (From -To)

Reason of Leaving

Last salary Drawn

Experience -4

Key Responsibility

Name & Address of Employer

Designation on Joining& leaving

Period (From -To)

Reason of Leaving

Last salary Drawn

If the given space is not sufficient, please fill-in extra sheet provided at the end of form.

IMS/47/01/FOR/11
Ed-01, Is-01, 15.08.2011

FAMILY BACKGROUND

VI.

Relation

Name

Age

Occupation

Education

Dependent

REFERENCE DETAILS

VII.

Specify, other than relatives preferably senior executive in any government or private organization.
Reference

Reference II

Name & Full Address

Designation

Organization

Contact No.

OTHER DETAILS

VIII.

If you have appeared for Test/Interview earlier, with Shree Cement , kindly furnish details as below :

Date of Test/Interview

Position

Whether selected & offered employment ?

Foreign stay or travel if any ?
Countries visited

Yes/No
Time Duration

Purpose of Visit

Is any legal proceeding (civil/criminal) pending against you in any court of law or have ever been found guilty by any
court of law ?
Yes/No
If yes, give details of the matter.

I certify that the information furnished above is factually correct and subject to verification by SCL (including reference check and background verification). I
accept that an appointment given to me on this basis can be revoked and / or terminated without any notice/compensation at any time in future if any
information has been false, misleading or deliberately omitted / suppressed. I also certify that I am at present in sound mental and physical condition to
undertake employment with SCL.
Place
Date

Signature of applicant

IMS/47/01/FOR/11
Ed-01, Is-01, 15.08.2011
IX.

EXTRA SHEET FOR WRITING PROFESSIONAL EXPERIENCE (PAST)

Experience -5

Key Responsibility

Name & Address of Employer

Designation on Joining& leaving

Period (From -To)

Reason of Leaving

Last salary Drawn

Experience - 6

Key Responsibility

Name & Address of Employer

Designation on Joining& leaving

Period (From -To)

Reason of Leaving

Last salary Drawn

Experience -7

Key Responsibility

Name & Address of Employer

Designation on Joining& leaving

Period (From -To)

Reason of Leaving

Last salary Drawn

Experience -8

Key Responsibility

Name & Address of Employer

Designation on Joining& leaving

Period (From -To)

Reason of Leaving

Last salary Drawn