Robert Bosch Engineering and Business Solutions Limited

Application for Employment

(Recent Passport Size

Position applied for Location Date Photograph To Be Affixed
(dd/mm/yyyy) During The Time Of
Interview)

General Instruction
Type or print this application form ; Specify all dates using DD/MM/YYYY format ; If
not hand written, sign at the bottom of each page

Personal Information

First Name Middle Name Last Name

Date of birth (dd/mm/yyyy) Gender E-Mail ID

Place of Birth: City & State Mother Tongue Nationality Religion

Date of Name
Change of Name if Applicable (Former Name / Maiden Name )
Change

Date of Issue Valid till
Passport Number Place of Issue ECNR
(dd/mm/yyyy) (dd/mm/yyyy)
Any ID issued by a competent Government or other agency? (Driving licence, passport, PAN card, Phone bill,
Bank passbook others) :
If yes, Please attach photocopy of anyone document.

Current Address
Door No. House Name
Street

Landmark
City State Pin
Residence phone with STD Mobile
Number

Permanent Address : Same as Above

Door No. House Name
Street

Landmark
City State Pin
Residence phone with STD Mobile
Number
Domiciliary state Period of
stay

Family Information
Marital Status Date of Marriage (dd/mm/yyyy) :

Spouses Name - First Middle Last Occupation
Number of children No. of dependents
(Other than Spouse &

KG Campus, No.363, Thudiyalur Road, Saravanampatti, Coimbatore 641035, India 1

Telephone: +91 422 663 4000 Telefax : +91 422 663 4104
Registered Office : 123, Industrial Layout, Hosur Road, Koramangala, Bangalore 560 034, India
Robert Bosch Engineering and Business Solutions Limited
Children)

Fathers Name - First Middle Last Occupation

Mothers Name - First Middle Last Occupation

Education (Begin with the highest education qualification & end with class X; Attach legible photo copies of
Mark sheets / Degree Certificate / Provisional Degree Certificate)

Year of passing
Name of
Course / Specializati (Month / Year) % of Class /
Institute / Location
Degree on Marks Rank
University
From To

Post

Graduation

Graduation

Diploma

Pre-University /

12th Std

School / 10th

Std

Others

Please provide additional information for Post Graduation

Post
I SEM II SEM III SEM IV SEM V SEM VI SEM Aggregate
Graduation

Percentage

Backlogs

Please provide additional information for Graduation

Aggregat
Graduation I SEM II SEM III SEM IV SEM V SEM VI SEM VII SEM VIII SEM
e

Percentage

Backlogs

Please provide additional information for Diploma

KG Campus, No.363, Thudiyalur Road, Saravanampatti, Coimbatore 641035, India 2

Telephone: +91 422 663 4000 Telefax : +91 422 663 4104
Registered Office : 123, Industrial Layout, Hosur Road, Koramangala, Bangalore 560 034, India
Robert Bosch Engineering and Business Solutions Limited

Diploma I SEM II SEM III SEM IV SEM V SEM VI SEM Aggregate

Percentage

Backlogs

KG Campus, No.363, Thudiyalur Road, Saravanampatti, Coimbatore 641035, India 3

Telephone: +91 422 663 4000 Telefax : +91 422 663 4104
Registered Office : 123, Industrial Layout, Hosur Road, Koramangala, Bangalore 560 034, India
Robert Bosch Engineering and Business Solutions Limited

Professional Work Experience (Present / Last Employment)

Company
Key job responsibilities
Name
Building
Street
No.

Landmark
Cit
State Pin
y

Employee ID
Current Designation &

Department
Date of joining
Reason for seeking change Last drawn salary
Supervisors Name &

Designation
Supervisors Direct Number &

Mail Id
Type of employment
Are you under any bond?
If yes, specify bond period or amount / period
Can the employer be If No, then provide an alternate date to contact
contacted now?
Reporting structure

Professional Work Experience (Past Employment)

1. Name of the company Key job responsibilities
Building Stree

No. t

Landmark
City State Pin
Date of joining & Leaving
Duration of employment Last drawn salary

Reason for seeking change

2. Name of the company Key job responsibilities

Building Stree

No. t

Landmark
City State Pin
Date of joining & Leaving
Duration of employment Last drawn salary

KG Campus, No.363, Thudiyalur Road, Saravanampatti, Coimbatore 641035, India 4

Telephone: +91 422 663 4000 Telefax : +91 422 663 4104
Registered Office : 123, Industrial Layout, Hosur Road, Koramangala, Bangalore 560 034, India
Robert Bosch Engineering and Business Solutions Limited
Reason for seeking change
Please use additional sheet (annexure I) if space is not sufficient.

Technical & Domain skills (List skills which relate to the position applied for & rate them as per
scale defined)
1 Basic Awareness; 2 End user; 3 Require guidance; 4 Can deliver independently; 5
Ability to train / guide others
Skill Description Self Evaluation

Training / Development Program / Certification (Specify date in dd/mm/yyyy format)

Name & Location of
Program Details From To
Institution

REFERENCES
Details of persons under whom you have either worked or who know you professionally for at least 6 months
Organization Nature of Phone No. (With STD
Name & Duration Associatio E-Mail ID Code)
Designation n Residence Office

Details of friends / relatives employed in BOSCH

Phone No. (With STD
Organization Nature of Code)
Name & Duration Associatio E-Mail ID
Designation n Residenc
Office
e

KG Campus, No.363, Thudiyalur Road, Saravanampatti, Coimbatore 641035, India 5

Telephone: +91 422 663 4000 Telefax : +91 422 663 4104
Registered Office : 123, Industrial Layout, Hosur Road, Koramangala, Bangalore 560 034, India
Robert Bosch Engineering and Business Solutions Limited

KG Campus, No.363, Thudiyalur Road, Saravanampatti, Coimbatore 641035, India 6

Telephone: +91 422 663 4000 Telefax : +91 422 663 4104
Registered Office : 123, Industrial Layout, Hosur Road, Koramangala, Bangalore 560 034, India
Robert Bosch Engineering and Business Solutions Limited

Additional Details

Professional Achievement
Membership of
Professional
Association
Research Papers /
Articles published
Patents / License
Registered

Interests
Achievements in
Sports, Literary
activities etc.

Awards received

Hobbies & Special

Interests

Health

Height (Cm) Weight (Kg) Blood Group Physical handicaps, if any, please provide
details

Have you suffered from any major illness / Surgery /

accident in the last five years? If yes, please provide details

Chronic illness if any (high blood pressure, diabetes, etc)
Information on major surgical operations if any
Information on most recent illness, if any

Statutory Membership Account Number

Are you a member of Employees Provident Fund Scheme

(EPF)?
Are you a member of Family Pension Scheme (EPS)?
Are you a member of Employees State Insurance Scheme

(ESI)?

Contact person in case of emergency (preferably local) :

Name
Door Number Relationship
House Name
Street
Landmark
City State Pin

KG Campus, No.363, Thudiyalur Road, Saravanampatti, Coimbatore 641035, India 7

Telephone: +91 422 663 4000 Telefax : +91 422 663 4104
Registered Office : 123, Industrial Layout, Hosur Road, Koramangala, Bangalore 560 034, India
Robert Bosch Engineering and Business Solutions Limited
Residence
phone with Mobile Number
STD

KG Campus, No.363, Thudiyalur Road, Saravanampatti, Coimbatore 641035, India 8

Telephone: +91 422 663 4000 Telefax : +91 422 663 4104
Registered Office : 123, Industrial Layout, Hosur Road, Koramangala, Bangalore 560 034, India
Robert Bosch Engineering and Business Solutions Limited

Language Proficiency

Language

Can Speak

Can Read

Can Write

Other Details

Have you been interviewed by Bosch before? If yes, provide details (Division / Location / Month /
Year)

Have you ever been arrested, prosecuted or
convicted for any criminal offence, other than minor
traffic offences If Yes, provide details

Social security no. / any ID no. issued by competent

Government office If Yes, specify the details

Do you have any commitment to another employer

or organization that might affect your employment
with us? If Yes, provide details

Any other information you would like us to know which may have significant bearing on our hiring decision?
If Yes, provide details

Certification by Candidate

I certify that the statements made by me above are true, complete and correct. I agree that in case the
company finds at any time, the information provided by me in this application form is not correct, true or
complete, the company will have the right to withdraw, if selected, the letter of appointment before I join the
services or to terminate my appointment at any time without notice or compensation after I have taken up
service.

I authorize Robert Bosch Engineering & Business Solutions Ltd. or its agency to verify my
credentials. I will cooperate and facilitate the process of verification of my credentials / antecedents.

Name of the applicant Date Place Signature

KG Campus, No.363, Thudiyalur Road, Saravanampatti, Coimbatore 641035, India 9

Telephone: +91 422 663 4000 Telefax : +91 422 663 4104
Registered Office : 123, Industrial Layout, Hosur Road, Koramangala, Bangalore 560 034, India
Robert Bosch Engineering and Business Solutions Limited

Remuneration Details : Annexure II

Name:
Please furnish your present remuneration
Date of last salary revision:
details.
Date of next salary revision:
Compensation Element Amount (Rs.) Remarks

1. Cash components per month:

Basic Salary

Dearness Allowance

House Rent Allowance

Conveyance Allowance

Childrens Education Allowance

Special Allowance

Other Perquisites

Gross Salary per month

2. Retirals:

PF

Gratuity

Superannuation

Total Per month

3. Cash components per annum:

Incentives

Bonus

LTA

Other Perquisites

Total

CTC ((1+2) X 12 +3 )

Deductions / Recoveries, if any

CTC Per Annum

Expected CTC Per Annum

I certify that the particulars furnished by me are correct.

Date :
Signature

Note: Please attach a copy of last drawn salary slip / other endorsement in support of the

KG Campus, No.363, Thudiyalur Road, Saravanampatti, Coimbatore 641035, India 10

Telephone: +91 422 663 4000 Telefax : +91 422 663 4104
Registered Office : 123, Industrial Layout, Hosur Road, Koramangala, Bangalore 560 034, India
Robert Bosch Engineering and Business Solutions Limited

above particulars.

Professional Work Experience (Annexure I)

3. Name of the company Key job responsibilities
Building Stree

No. t

Landmark
City State Pin
Date of joining & Leaving
Duration of employment Last drawn salary
Reason for seeking change

4. Name of the company Key job responsibilities

Building Stree

No. t

Landmark
City State Pin
Date of joining & Leaving
Duration of employment Last drawn salary
Reason for seeking change

5. Name of the company Key job responsibilities

Building Stree

No. t

Landmark
City State Pin
Date of joining & Leaving
Duration of employment Last drawn salary
Reason for seeking change

6. Name of the company Key job responsibilities

Building Stree

No. t

Landmark
City State Pin
Date of joining & Leaving
Duration of employment Last drawn salary
Reason for seeking change

KG Campus, No.363, Thudiyalur Road, Saravanampatti, Coimbatore 641035, India 11

Telephone: +91 422 663 4000 Telefax : +91 422 663 4104
Registered Office : 123, Industrial Layout, Hosur Road, Koramangala, Bangalore 560 034, India
Robert Bosch Engineering and Business Solutions Limited
Name:

Date: Signature

KG Campus, No.363, Thudiyalur Road, Saravanampatti, Coimbatore 641035, India 12

Telephone: +91 422 663 4000 Telefax : +91 422 663 4104
Registered Office : 123, Industrial Layout, Hosur Road, Koramangala, Bangalore 560 034, India