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
EMPLOYMENT DESIRED :
Position desired ______ Salary desired _____________________________Date you can start_____________________
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
MISCELLANEOUS INFORMATION :
Extra-curricular activities (Debates / Dramas/ Sports etc)___________________________________________________________________
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.
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 :