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CONTEL

SM – 8, Sector- 5, (City Centre) Panchkula


Tel: 91-172-2568774 Fax: 91-172-2640511

Please attach a recent


APPLICATION FOR EMPLOYMENT PHOTOGRAPH

NOTES TO APPLICANT :
(1) Please fill in the form completely. Leave no columns blank. Be specific in your replies.
(2) Use blank space on page 3 for any additional information you consider relevant.

PERSONAL INFORMATION :
Name (Mr./Mrs/Miss) Age_________________
(First Name) (Middle Name) (Surname)

Present Address__________________________________________________________________________________________________
Permanent Address________________________________________________________________________________________________
Phone No. FAX No. E-mail address Nationality________________

Do you have your own home? ___ Rent Paid Do you have own conveyance? Car Scooter
_________
Date of Birth Height Weight Colour of Hair Colour of eyes ________ ______
Married : YES / NO Date of marriage Single Widow Divorced Separated_______
If related to anyone in our employment Referred by
state name and department ____________________________ ___________________

FAMILY HISTORY :
Family Name Age Education Occupation Annual Location
Member (years) (with exact nature Income (mention city)
place of work) (Rs)
Father

Mother

Brothers

Sisters

Spouse

Sons

Daughters

Do you have any other dependents


such as unmarried sisters?__________________________________________________________________________________________

EMPLOYMENT DESIRED :
Position desired ______ Salary desired _____________________________Date you can start_____________________

Are you employed now?__________________________ If so may we enquire of your employer? _________________________________


Ever applied to this company before? ___________________ When?______________________ Where? _________________________
Have you applied anywhere else? ____________________ If yes, status __________________________________________________
Years Attended Degree/ Division / Subjects
EDUCATION Name & Location of Exam % age Studied
From To
School/Institute
th
10

12th

Graduation/
Degree/
Diploma
Post Graduation/
Other Qualification

COMPUTER LITERACY
Examination Name of Board/ Years Attended Degree / Division / Operating Languages Packages
Passed University Exam % age System
From To

Reasons for gap in educational history _________________________________________________________________________________


Failure in any course __________________________Reason for low gades___________________________________________________
Academic achievements / Honours / Scholarships________________________________________________________________________
Have you applied for Studies Overseas/Outstation ___________ If yes, where? ___________________ Status? ______________________
Subjects of special study or research work______________________________________________________________________________
What Foreign Languages do you speak fluently? ____ Read Write_____________________________
FORMER EMPLOYERS : (List below your current employer and the last 3 employers, starting with current one first)
Date Name & Address of Salary Position Reason for
Month Company/Firm List Salary at Start (S) & Type of Work Leaving
& Year And on Leaving (L)
Basic Allowances Total
From S
To L
From S
To L
From S
To L
From S
To L

Reasons for seeking a new appointment :______________________________________________________________________________

1. Total years of experience :


2. Reasons for gaps in employment history :
3. Total No. of Job changes :
4. Job Responsibilities (Current employment) :
(a) (b)
(c) (d)
(e) (f)
5. Present Remuneration Details (per month) :
Basic PF Other Allowances & Perks Salary revision
1)
HRA ESI Last revised on __________
2)
Conveyance Bonus Next revision due ________
DA Medical/ 3)
Expected raise Rs. _______
Others LTC
Canteen
Sub Total ___________ Sub Total ____________ Cost to Co. _____________

Do you object to going to Geographic location


Any part of the country? : Yes/No preferred : 1. _________________ 2 _________________ 3.________________
(Mention city)
Do you object to shift work? : Yes/No

MISCELLANEOUS INFORMATION :
Extra-curricular activities (Debates / Dramas/ Sports etc)___________________________________________________________________

Member of any Cultural / Social / Political Organisation ____________________________________________________________________

Hobbies, Areas of Interest, Pastimes __________________________________________________________________________________

Seminars / Workshops / Courses attended _____________________________________________________________________________

Newspapers / Periodicals regularly read _______________________________________________________________________________

Memberships of Professional Associations _____________________________________________________________________________

REFERENCES : Give below the names of three persons not related to you (preferably previous employers) who can testify to your
professional capabilities and three personal references whom you have known at least for 3 years.
PROFESSIONAL : (NOT RELATED )
Years
Name Address Tel. No. Business / Profession Known
1.

2.

3.

PERSONAL : (NOT RELATED )


Years
Name Address Tel. No. Business / Profession Known
1.

2.

3.

PHYSICAL RECORD :
List any physical defects Have you had major injuries? _________________
___
Have you any defects in hearing? In Vision? In Speech?________________________
In case of emergency
notify (Name & Address)____________________________________________________________________________________________
Have you ever been tried in a criminal court? ___Have you ever been in police custody/arrested? ______________________
Is any court case/police enquiry pending against you?_________________________________________________ ________________

Date : __________________
Signature of Applicant
I authorize investigation of all statements contained in this application. I understand that misrepresentation or omission of facts called for is
cause for dismissal.______________________________________________________________________________________________
SPACE FOR ADDITIONAL INFORMATION :

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