EMPLOYMENT APPLICATION

LARSEN & TOUBRO LIMITED

POST APPLIED FOR .-Upstream Engineering ADVT REF

To be filld in by the applicant clearly and completely

( SURNAME ) HOW DO YOU PREFER YOUR NAME WITH INITIALS TO BE STATED IN WRITTEN COMMUNICATION ?

( FIRST NAME )

( MIDDLE NAME )

PRESENT HOME / MAILING ADDRESS / ADDRESS FOR COMMUNICATION

Please affix your recent Photograph

CITY PIN CODE EMAIL PERMANENT HOME ADDRESS

TEL NO. (with STD)

MOBILE NO CITY PIN CODE TEL NO BIRTH DATE RELIGION STATE OF DOMICILE CASTE ( DD/MM/YYYY ) SEX MARITAL STATUS NO. OF CHILDREN

AGE (Yrs) NATIONALITY BIRTH PLACE

PERSONAL DATA

NATIVE STATE FOR SCHEDULED CASTE/TRIBE

PERIOD OF STAY IN STATE WHERE RESIDING NOW ( YRs )

TYPE OF ACCOMMODATION ( Select appropriate option from the list )

Languages Speak Read

SUBCAST Monthly Rental / Charges Paid for Accommodation

Write

Rs.

LANGAGUES KNOWN ( Start with Mother Tounge)

FATHER'S NAME

AGE

DETAILS OF OCCUPATION (IF RETIRED, STATE LAST OCCUPATION)

DETAILS OF FAMILY MEMBERS (Please give full details of family members including parents, spouse, children and anyother dependents)
Name Age Relationship Occupation

EDUCATION DETAILS
FULL / PART TIME

Duration of Course

EXAMINATION PASSED

SPECIALISATION

SUBJECT

YRS MTHS

SCHOOL / COLLEGE INSTITUTION

NAME OF UNIVERSITY

DEGREE / GRADE DISTINCTIONS / YEAR OF DIPLOMA % SCHOLARSHIPS / PASSING CERTIFICATE MARKS PRIZES WON AWARDED

SSC or Equivalent School Leaving Certificate Intermediate or 12th Standard / HSC

MEMBERSHIP OF PROFESSIONAL INSTITUTE NAME OF INSTITUTE TYPE OF MEMBERSHIP AND POSITION HELD PERIOD DURATION OF MEMBERSHIP FROM TO

Post Grad. Degree / Diploma Certificate

DEGREE

DIPLOMA

Name of the Training Course Training

Duration

Year

Institute / Orgazination

Whether Certificate Awarded

TITLE Papers Published / Presented

NAME & DATE OF THE SEMINAR/JOURNAL IN WHICH PRESENTED / PUBLISHED

EXTRA CURRICULAR ACTIVITY (e.g. sports,social & Literary activities etc.)

ACTIVITY

INSTITUTION / ASSOCIATION SOCIETY / CLUB

YEAR

POSITION HELD

PRIZES WON

HEIGHT (cms)

WEIGHT (Kg)

POWER OF GLASSES

IDENTIFICATION MARKS

PHYSICAL DISABILITY IF ANY

HEALTH DATA

MOST RECENT SERIOUS ILLNESS

FROM

TO

NO. OF DAYS

NATURE OF ILLNESS

Do you or your spouse suffer from any of the following conditions/diseases 1. Diabetes 2. Cardiac 3. Asthma Have you ever been involved in any criminal proceedings / convicted of any offence ? CRIMINAL RECORD If yes, Please give details 4. High Blood Pressure 5. Other major illness/major operation & duration

III

WORK EXPERIENCE In unbroken chronological order starting from your first employment and ending with present employment (please account for all the periods of time not covered by education / training)
EMPLOYER'S NAME & ADDRESS (Please give Full address) DURATION
LAST POSITION HELD / DESIGNATION

NATURE OF DUTIES

From TO No. of Yrs . From

LAST POSITION HELD / DESIGNATION NAME & DESIGNATION OF IMMEDIATE SUPERVISOR

GROSS EMOLUMENTS (Rs. PER MONTH) AT THE TIME OF JOINING LAST DRAWN

AT THE TIME OF JOINING

TO No. of Yrs . From

NAME & DESIGNATION OF IMMEDIATE SUPERVISOR

LAST DRAWN

LAST POSITION HELD / DESIGNATION

AT THE TIME OF JOINING

TO No. of Yrs . From

NAME & DESIGNATION OF IMMEDIATE SUPERVISOR

LAST DRAWN

LAST POSITION HELD / DESIGNATION

AT THE TIME OF JOINING

TO No. of Yrs . From

NAME & DESIGNATION OF IMMEDIATE SUPERVISOR

LAST DRAWN

LAST POSITION HELD / DESIGNATION

AT THE TIME OF JOINING

TO No. of Yrs .

NAME & DESIGNATION OF IMMEDIATE SUPERVISOR

LAST DRAWN

From

LAST POSITION HELD / DESIGNATION

AT THE TIME OF JOINING

TO No. of Yrs . From

NAME & DESIGNATION OF IMMEDIATE SUPERVISOR

LAST DRAWN

LAST POSITION HELD / DESIGNATION

AT THE TIME OF JOINING

TO No. of Yrs .

NAME & DESIGNATION OF IMMEDIATE SUPERVISOR

LAST DRAWN

DETAILS OF CURRENT EMOLUMENTS

EMOLUMENTS MONTHLY (Per Month)

PARTICULARS

YEARLY (Rs.)

Present (Rs. p.m.)

Expected (Rs. p.m.)

Proposed (to be filled by L&T)

BASIC DEARNESS ALLOWANCE OR EQUIVALENT HRA

MONTHLY EMOLUMENTS

CONVEYANCE (Do you own a Car / any other vehicle) CITY COMPENSATORY ALLOWANCE SALES COMMISSION / INCENTIVE EDUCATION ALLOWANCE ANY OTHER (Please Specify) i. ii. iii. SUB TOTAL (A) BONUS ( %) ON RS.

ANNUAL BENEFITS

LEAVE TRAVEL ASSISTANCE (LTA) ANY OTHER (Please Specify) i. ii. iii. SUB TOTAL (B)

RETIREMENT BENEFITS

PROVIDENT FUND ( BY EMPLOYER SUPERANNUATION GRATUITY SUB TOTAL (C)

%) CONTRIBUTION

GRAND TOTAL (A+B+C)

Medical Reimbursement Limit
HOSPITALIZATION

DOMICILLIARY

ANY OTHER (Please Specify)

Sr.No.

Particulars

Present

Proposed (to be filled in by Personnel Dept

OTHER PERQUISITES

VI

Draw in the brief organisation structure of the Company where you are presently employed indicating two levels above you and one level below your position. (Please also indicate the total number of persons under you).

SIGNIFICANT ACHIEVEMENTS : mention some of the major contributions made by you in your present and previous jobs :

EXPLAIN WHY YOU CONSIDER YOURSELF SUITED FOR THE POSITION

VII

Have you ever been interviewed by any of the L&T Group of Companies

If Yes, give details

Date/Year

Position

YES / NO Company

NAME

RELATIVES / ACQUAINTANCE IN L&T GROUP OF COMPANIES RELATIONSHIP POSITION

COMPANY

Who referred you to us ?

GENERAL DATA

Are you engaged in any Personal Business ? If yes, indicate nature of business

YES / NO

DO YOU HAVE ANY CONTRACT / BOND WITH YOUR PRESENT EMPLOYER If Yes, Please give details YES / NO

If selected, when can you join ?

1.

Name & addresses of Two references. (Not Relatives) 2.

DECLARATION UNDER SECTION 314 OF COMPANIES ACT, AS AMENDED IN 1974 ( Strike out whichever is not applicable ) I hereby declare that I am not connected with any of the Directors of the Company as his partner or his relative as defined under Section 6 of the Companies Act, 1956. OR I hereby declare that I am a partner or relative of Mr. A Director of the Company as .
I declare that the information given above is true to the best of my knowledge. I am aware that any false or incorrect information by me may result in termination of my services with the Company. I have no objection to your inquiring from any of my previous employers on any matters pertaining to me, if I join your Company

Place : Date :

Applicant's Signature