Please write clearly in your own handwriting using block letters: Name : (Surname First) Mr. / Mrs. / Ms.

: Qualifications : (Degree / Diploma - with details) Present Address Permanent Address

Deputee Personal Information Form

Affix Recent Passport size Photograph

Tel. No. : Staying at present address since : Birth Date: __ / __ / 19__ Birth Place : _____________ Fathers Name : Mr. Occupation : Brothers Name : Edu. Qual. : Spouses Name : Edu. Qual. : Occupation :

Tel. No. : Home Town : Marital Status : Single / Married Sex : Male / Female

Mothers Name : Mrs. Occupation : Sisters Name : Edu. Qual. : Sons - Name : No. of Children Age : Daughters - Name : Age :

Language Proficiency : Languages you can (List the most fluent first) Read : Speak : Write : Have you been convicted of a crime?
Is any criminal case pending against you
Yes / No (#) Yes / No (#) Yes / No (#) Yes / No (#) Yes / No (#)

Physical Health 1. Do you suffer from any major aliment? 2. Did you ever undergo surgical operation? 3. Were you ever hospitalised 4. Were you ever dis-qualifited from job offer on medical grounds?

Yes / No (#) Yes / No (#) Yes / No (#) Yes / No (#)

(#) Note : In case of Yes answer give details

Were any disciplinary proceedings initiated against OR Punishment/Penalty awarded to you by any law enforcement agency? Do you object to going to any part of country?

Minimum monthly gross Salary Acceptable to you : Rs. ____________/If selected time required to join _______________

EDUCATIONAL PROFILE
Name(s) of School(s) attended : . Medium of Instruction :

College / Professional Education Details :College / Institute Year Attended From To Degree / Diploma Class % Marks

Specific details of computer exposure, Pl. specify Training, languages, systems known, actual work experience etc. Specify details of any other training, short courses attended

DETAILS OF EMPLOYMENT
(In Chronological Order and if more space is required, give details on a separate sheet) Employer Position held Period employed From To Last salary drawn / benefits Reasons for seeking change

Total Experiences as on date of Application : _______ Years

REFERENCES (min. Two) : Name 1. 2.

Note : Atleast one should not be relative. Designation Address & Tel. No.

In case selected, how long would you remain with us upon completion of Training / Probation period ? ________ Years.

DECLARATION
I do declare that the information given above is true and correct. I also understand that in case any information is found to be incorrect; my appointment If confirmed, would be terminated with immediate effect. Date : Place : Signature of the applicant ___________________

For Office use only: 1) Details of face to face : First Int. Next Int. Final Int. Date _ _ / _ _ /200_ _ _ / _ _ /200_ _ _ / _ _ /200_ By Remarks Sign

2) Outcome of face to face : 2.1) 2.2) 2.3) 2.4) 2.5) Selected / Not selected / Reasons for not selection . Date of joining With salary at Rs. Under training for ___ months + Probation for __ months. Salary during training Rs. ______; During probation Rs. ______.