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7J)q;fu:r/CONFIDENTIAL

~11i!ctt-cr;t31"lq=2~ ~:s KRISHAK BHARATI COOPERATIVE LIMITED

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(HUMAN

RESOURCE DEPARTMENT)

l!-10. ~-1. o::firn-201301. ~ JflC1Ji!!;&FrTI~(00JfO) A-l0, SECTOR-l, NOIDA-201 301, DISTT. GAUTAMBUDH NAGAR(U.P.)

3IldC4., JIQ';I" APPLICATION FORM

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Please affix passport size photograph

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Application for the post of

Name of- the Applicant

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Address for Correspondence

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Pleasefill up this application form in your own handwriting. 11m ~ ~ if ~ cIT. ~ 3WPT "'rO ~ if ~ I If the space provided in the application form is in:$ufficient, please attach continuation sheet. 3. cpRIT wnur l:BIT,mRrr ~ qff JfFcRn' ~ if ~ I Please do not attach copies of the certificates/testimonials. 4. ~ lT43r ~ ~ 3lQCIT 7JC'fff ~ ~ 3lQCIT fc\;at ~ em- ~ tR

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Any false or incorrect information given in this form or suppression of any information termination of your services summarily. 5. 3TfCTGq; &RT ~ 1Jl! I4qio qff 4il\ilJle &RT ~ q~C1I(>t qff \7fT ~ t" I

may lead to

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All your statements are subject to verification

by Management.

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(Last) (Middle) (First)

Name (in block letters) Mr./Miss./Mrs. 2.

\Wif~-------3nCJI,------qi-----~-----.~----Date of Birth Age Years Months Days

3. q(ff/Address

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Present

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Permanent

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Home Town

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Residence
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qq;wICOlmfR>1t>1re1C01r Office
7.

Telephone No. (if any) 5. 'C1~COIC11, Nationality

8. r/Sex

~cpf_...,__-----Blood Group

Religion _ ~~~, ~ 9. Q)G/Heightl.3Tkcr/With Glass lefteye

10. CNJ'i'/Weightl.-

_ _ _

11. ~/Vision:-

oo 3Tkcr/Righteye,
00 3lRcr/Right eye:

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12.

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3Tkcr/Without Glass left eye

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FWwr WTl1!) I4qlffiC1/31l4qlffiC1rfflt:rcrr~-------------_ _

Marital Status (please tick) Married/Single/Widow/Widower

13.1?Rrr(Qfc!r 14.ftrcrr(Qfc!r

cnr rrflf/Name of Father/Husband cnr 6!lq'lflICOI (l4q'tol ~)/Occuption of Father/Husband with details,

15. q(ff q

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--.-,.,. _ Mark

Address & Telephone No. (if any), 16. ~ ~/Identification

17. CRIT ~

cor coW <t>4i11=l1 3lTQ'q}f qRRm err ~ t <IT ~ ell Are you known or related to any KRIBHCO employee ? If so, give details :

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18. CRIT 3IN ~t1'l<t>11I

~ ~{!'wfli!Ol &Ji!OICHWtfl ~ ~ <t>1i!i'lct ~ ?"i!OI1G <IT ~ l.iT el I Are you in the service of any Government or Local Self Government? If so, give details :
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19. CRIT 3IN ~

?"i!OI1G <IT ~ l.iT el I Have you been a candidate for any post inKRIBHCO before ? If so, give details :
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20. CRIT 3IN 3ljq:!ilct

~ l31jq:!ilct "'"'1"'1 fc!I/3Rr ~ ~ ~ ~ ?"i!OI1G <IT fflcRur l.iT Do you belong to Scheduled Caste/Scheduled Tribe/OBC ? If so, give details:

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Have your services ever been terminated from any previous employer?

If so, give details :

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How soon can you join duty if selected? 23. 't4lCfl14 ~-1C1Ji~/(tIqffiR~(1rf.fd:lifl"i!l~iti Minimum Salary/Emoluments
24. ~ i!l10li!lCiI ~ .m:ICIT ~~

Acceptable.
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Academic Qualifications (starting from Matriculation or equivalent onwards)

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Examination

~~ School/College

~q~tU(1i!1 University

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Year of Passing ~~ Main Subjects

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ClassjDiv.j Ofoof marks

25. Mffilll'lOI 'CflTfficRur/Detaiis of Training Undertaken:

~ S.No.

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Name of Organisation/Institution

~/Duration -a/From '(1Cf)/To

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Brief description of Training

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26.

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Experience

(starting

from

latest employment)

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S.No.

-a/From

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Name & Address of Organisation

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No. of persons supervised

~/Salary

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~"Cf)f CORUT Reasons for Leaving

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(Basic+Allow)

Designation/position held with brief description of duties and responsibilities

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Direct

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Indirect

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Starting

~~
Leaving

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27. 3Rr ~ ~/qldil(fl JIRI~~i!Oti~-~mfq;~) . Other Achievements (Academic/Extra curricular activities/Sports/Hobbies

etc.

28. ~q"dIR:!Cf> P1Cf>Ii!l1"

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Details regarding Membership of Professional Bodies:

29. CRIT 3J1tfOl 3JtR ~

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Any loan liability existing with the presentemplqyer?

(Give Details)

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30. ~ qft "W1Cf)11I : (qJfltfCl ctR' .... cm:r, cftq;, ~, Languages Known : (Uttle, Fair, Good Very Well) ~ S.No.
1ffIU

3liSt)

Language

~ Speak

tJCfIT Read

f(q&"'11 Write

31. Cf)1~iC"l~ q:;tlillt ~ ~ ~ qft ~ crn>ft 1ffIU/~ Specify Language(s) for Official Communication:

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B.
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A.

71'. C.

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Have you ever been Arrested or Convicted by any Court of Law?

If so, give details:

33. CRIT 3I'TQ" ~ ~ IiI"'1RiCf) err 4!lh!'lRCf) 31i1IIiI""4C11~ ? ~ ~, fc\cRur Do you have any Mental or Physical Disability? If so give details :

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34.CRIT

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Do you have any Chronic or Continuing Disease? It so, give details:

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3fjqRerrr ~ List all illnesses during the previous Ten Year which have resulted in your absence from duty for more than Two weeks :

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Please

(a) In case you want your Parents/Wife/Husband/Children furnish the following details:
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to be considered as Dependents,

S.No 1.

Name

~ ffrIir Date of RelationBirth ship

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Placewhere Marital Status normallyresidence

Occupation Address)

31'Rf ~o

Ann. Income (Rs.)

2. 3. 4. 5. 6.
7.
,;

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(b) Details about Sisters and Brothers:

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~ 3ffJF CilCiit I~ (qm) Occupation Address)

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S.No

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Name

Date of RelationBirth ship

Marital Placewhere Status normallyresidence

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Ann. Income (Rs.)

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(c) If any of your dependents is suffering from Chronic/Long Lasting Physical or Mental illness, please givedetails:

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Any other particulars you wish to mention which are relevant and particularly qualify you for the post :

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What are your personal attributes/shortcomings

which have some bearing on your work?

39. ~

~lffq it EI"ffTlt "Fcf;.3lTQ'CI5T~ tJG cti ~ a4'4Cfi1 CRIT ~ \1fT(! ? Give a brief resume Indicating why you consider yourself suitable for the post?

40. ~

cnr icrcRur G', \1Il.3lTQ'Cl5T ~ Give two references (other than relatives) 'ifTJf Name

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W"4OT

S.No.

Full Address

Mllf))"'1 rfo Telephone No. Since when he ~~

YOU

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has known

41. ~ oaFcffi~1' cnr rrTJr, "4OT c=rm e.c4llf))"'1 "'f1ER", c:rffl""tIT ffflj ~ 3lffilq%!~Ch~ tR" ~"Fc6m" \JIT ~ Name, Address & Phone No. if any, of two persons who should be contacted in cases of any emergency :

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Telephone No.

Home Town

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_________ hereby declare that the information given above is correct tothe best of my knowledge and that nothing has been concealed.

crrit?CI"/Date &Ff/Place

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t\=tC1ltfR/Signature

_ _

W rrTJr/Full Name: