Employment Application Form

Thank you for your interest in CRH Group of Company. This form is intended to enable you to record important points about yourself, your
experience, your achievements and your plans for the future. Please complete the form in full and use additional sheets if necessary. When we
meet you at the interview, the contents of this application will provide a base for our interaction.

PERSONAL INFORMATION Kindly affix a

Passport size
First Name Middle Name Last Name Photograph
Her

Mr./Ms.: ( Expand all names)

Date of Birth
e-mail:
Current Address:
City: State: PIN Offic
Phone (with
e
STD code)
Res.
Permanent Address:
City: State: PIN Phone (with STD
code) or mobile
Skype ID

EDUCATION

(Begin with the most recent qualification and end with Std. X)

Course/Degree Specialization Name of Institute /University Address Graduation Aggregate

(Month/Yr. Marks
)
(% or CGPA)

TRAINING

Training/Development Programmers attended / Skills Institute / Organization Location Dates attended

acquired From To

WORK EXPERIENCE
Number of Companies Worked for (Count should include the Present Employer).

CURRENT EMPLOYMENT

Name of the Employer: Address:

Number of Employees: Sales Turnover:

Phone:
Date Employed From To Notice Period :1-2 month
Your Designation & Department: Employee Responsibilities:
Code-

Reason for Leaving:

Supervisor’s Name & Designation, EMAIL ID & Contact Number:
Can we take reference from your supervisor?☐ Yes ☐No

Deputation Details :( Mention name of organization to whom you were deputed

through current employer Please mention NA if not applicable)

MONTHLY EMOLUMENTS

Fixed Salary Variable / Perks Deferred benefits

Basic Housing PF, Pension, Gratuity etc. (C)

Bonus/Incentives Company car

Allowances Furnishings Monthly Gross (A+B+C)

Others

LTA (/ p.a.) Others Variable (……../p.a)

Current Annual Gross
Food Coupons (please specify)

(please specify)
Total (A) Total (B) Expected Annual Gross

If yes, Nett gain at current value :

{(Current Market Price – Issue price) x No. of stocks}

Do you have employee stock options? ☐ Yes ☐No

PREVIOUS EMPLOYMENT

Name of the Employer: Address:

Dates Employed: FROM TO

Phone:
Your Designation & Department: Employee Responsibilities:
Code

Reason for Leaving :) Monthly Gross:

Supervisor’s Name & Designation, EMAIL ID & Contact Number

Name: -Designation: - Group Leader Email: -

Deputation Details :( Mention name of organization to which you were deputed
through current employer. Please mention NA if not applicable)

ALL OTHER PREVIOUS EMPLOYMENT DETAILS

Name of the organization Location Designatio Employee Duration Monthly Salary Reason for
n Code From To Starting Final Leaving
ABOUT YOURSELF

The answers to the following questions will help us get a better understanding of you as a person.

Your personal strengths? Your personal areas of improvement?

Your career objectives? Your expectations from the job/CRH?

SIGNIFICANT ACHIEVEMENTS:

OTHER INTERESTS: Cultural, sports, community work and hobbies from school onwards & details of memberships of association

REFERENCES

Give references under whom you have either worked or who know you professionally for at least 6 months.

Name Duration & Organization & Designation e-mail Phone (with code)
Nature of Home Office

Association

ADDITIONAL DETAILS

Position You Are Applying For

Do you have work permit to work in CANADA ☐ Yes ☐No

Nationality:

If Yes, Passport No:

Do you hold a valid Passport? ☐ Yes ☐No

Valid till:
 If Yes, Details

Have you been denied VISA to any country? ☐ Yes ☐ No

If yes, provide details on countries visited and type of Visas held

Have you worked on overseas assignments? ☐ Yes ☐ No

If Yes, Division: Location :

Have you attended any selection process at ☐ Yes ☐ No

CRH before?
Month/Year: Status :
Do you have any relative / friend employed? If Yes, his/her name:

With CRH? ☐ Yes ☐No Division/Location:

Have you suffered from any major illness? If Yes, Details

/surgery /accident in the last five years? ☐ Yes ☐No

Have you ever been arrested, prosecuted or convicted for any criminal If Yes, furnish details including type of offense and conviction
offense, other than minor traffic offenses ? ☐ Yes ☐No
Yes ( ) NO ( )
In the last ten years, have you been convicted of or plead guilty to any
offence?☐ Yes ☐No Yes ( ) NO ( )

In the last ten years have you been released from prison on a
conviction? ☐ Yes ☐No

Do you have any commitment to another employer or organization that might affect your employment with us? ☐ Yes ☐ No
Any other information you would like us to know which may have significant bearing on our hiring decision:

WORK LOCATIONS

Are you willing to be posted anywhere? ☐ Yes ☐No If no, Why?

Indicate your preferred work location in USA or Canada:

DECLARATIONS

1. I hereby declare that my statements on this form and on my resume or documents provided by me to CRH Group of Company
are true and correct to the best of my knowledge.
2. I understand that CRH, at its discretion, may institute and conduct a background check to verify the information furnished by
me in this form. CRH assures me that background check on my current employment will be taken up only post my joining
CRH and this is acceptable to me.
3. I authorize all persons who may have information relevant to the verification to make disclosures to CRH or its representatives/
agents.
4. I acknowledge and agree that providing any false information may result in a decision not to hire me or if hired, may result in
termination of my employment.
5. I understand that CRH may notify and publish any information provided by me that is found false. In addition, I understand
and agree that CRH Group of company has rights to seek any legal remedies including indemnification and damages from me
for any loss caused to CRH as a result of any such false information.

Name: Date: Place: Signature: