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.A ChokseyChemicalsP. Ltd.

" 11'1,IndustrialArea,Sion(E),Mumbai- 22.


GHOKSEYfel - 022 24090124I 127.
PosilionAppliedFor I

LocationPrefercnce:

PERSONALDATA
PASSPORT
SIZE
(Sumame) (Firs0
PHOTOGRAPH
(Middle)

AddEss for

Dateof Birth:
&€ :
Placeot Birth:
(Dist.State)
P6man6nt
Height: Cr|s--
Weight Kgs.-
Physlcaloisabillli€a,if any
MaritalM|s:
Ldguage€ltrorvn Speek Rgad wfits Single Manied D
(lMFrTongu€ First) E
Wdow€d Divorced
EI
- :
No. of Children
Male: _ Age_
Female: _ Age,_

ToialFamilyhicome :
{perannum):
Rs.-

FAMILYBACKGROUNO:

Relationship NaIne &e Employer/ Ociupation Designation


Fathet

Molher

Spouse
Broiher (s)

Sisler (s)

f_ {
ACAOEMICQUALIFICATIONS:
PERIOD Class/
SchoouCollege/ Univercity/ Degree/ Medium Specialisatiorv Grade/
lnstitulionand Location To ot Electives
Board
Mth. Yr. Mth.Yr.
Diploma
lnstruclior v.

and Prizes
Scholarships

T|aining):
SpecialTEinir€,ifany(Prcjec{work, Cou6s Assignmetd,Technical

EXTRA€URRICULAR ACNIVMES/ HOBBIES,IINTERESTS


(Whatal hasbeenyourlei;l of padicipationin eadr?)

ls anyrelatveemployedwith us?Yes/No. lf yes pleasesiate:


Name DesignaliorVLocation Relalionship
Iemploylaem
oErnllglglgtt
l-t " {t"IltEovt+ for
Reason(s)
of Employer Leaung
Name& Address

8def,youtllneyourpresentjob responsibilitigs:

placeYes/No(Phooe--------jJ
Maywe call youdiscteetlyat yourwoft
madeto youtpEvlous(not@nent)employe(sF Yes/No'
Do you haveatryobiectonsio tefetenc€being

ffi:**$:##ill#ffis;!i*t

Oetailsof PEsentEmolumenG:
HRA.- ConveYance: Others:
Basic/ Salary-
MONTHLY: D A -- - -total-
Bonus:-...--Others: Toial:
ANNLAL: LTA Medlcal:
-

I selectedwh€ncanyou lbin?

yes' Pleasegivedetails:
Haveyou applledto us earlier? lf

likeus io clnsider
Anyadditionalinformationthat you may

ll

l
A
GHOKSEY
Reference:(other tian rclatlves
Name : FullAddress Tel.No.
Res.

on:
Res-

on:

fumishedin thisfom arelrue


I herebyafrrmthatall informalion

Plac€:

Dat :
ctEla6hips and Prizes
FOROFFIC€USEONLY

PrelimhtgMew held on: Final inteMew on:

Pansl : Panel:

Sign.bre of Pandl Members Sgnalureof Panel MembeF

SELECTED / REJECTED
/ WAITLISTED

It Select€d:

Po6,rtftn& Grade :

Funclioh:

Localion:

Expec,tedDaie of Joining:
HRMANAGEFV
HREXECUTIVE
BasicSalaryP€r Month: Rs.

i"

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