Passport size colo

r photo (To be
pasted)

PERSONAL INFORMATION FORM (for Technical / Admin Post)

POST APPLIED FOR :22/03/2019

FULL NAME IN BLOCK LETTERS: FATHER’S NAME:

M.VEENA
MUTHURAMAN

Date of Birth Age Sex Nationality Nativity Religion Caste

25/06/1977 41 F Indian Chennai Hindu OC

Marital Status: Married

Present Address Permanent Address

22/23, 2nd floor

vanier street -do-
near jones road
saidapet
chennai-15
E-mail:
Phone (landline)
Mobile Phone:
E-mail:veenuveenu7@gmail.com
Phone (landline)
Mobile Phone:9952948823

Name, Occupation & Address of Parents: Name, Occupation & Address of Spouse:

retired srinivasan
marketing manager in pvt. ltd

10 pv street, rajaji nagar

pallavaram
chennai-43 E-mail:
Phone (landline)
Mobile Phone:9003120586

E-mail:
Form No. Form No. HIS/HRD/NTAF/02/14 – Issue No. 1 Rev. 0 / Mar-14
 Phone (landline)
Mobile Phone:

HEIGHT:5' 3" WEIGHT:69 POWER OF SPECTS: (If using) null

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ACADEMIC & PROFESSIONAL QUALIFICATIONS (SSLC onwards)

Course
Year of Class /
(Exam Institution University Major subject
passing Marks %
passed)
SSC govt. hss govt. hss 1992 ENG, TAM, MAT, SCI, 83
SOC.SCI

HSC govt. hss govt.hss 1994 ENG, TAM, MAT, PHY, 63

CHEM, BIO

BSC vel's college madras 1995-1998 CHEMISTRY 74

university

MSC gurunanak madras 1998-2000 CHEMISTRY 68

college university

MBA university on madras 2010-2012 HR 64

madras university

Passport No: Driving License No: Aadhaar Card No. PAN Card No.

EXPERIENCE (Begin with latest employment)

Name &
Gross Reason for
Address of Designation Period Responsibilities
Salary leaving
the employer
Infogem web hr exec. 2012 to interview, admin
solutions 2014 28000 personal

TRAINING COURSES ATTENDED

Period Course title Conducted by Sponsored by

Form No. Form No. HIS/HRD/NTAF/02/14 – Issue No. 1 Rev. 0 / Mar-14

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Form No. Form No. HIS/HRD/NTAF/02/14 – Issue No. 1 Rev. 0 / Mar-14

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Form No. Form No. HIS/HRD/NTAF/02/14 – Issue No. 1 Rev. 0 / Mar-14

 DETAILS OF CHILDREN (if married) & DEPENDENTS
Name Age Relationship Occupation

Languages known (underline mother tongue) Physical disability / serious

accidents, if any
To read

To write
Blood Group
To speak

Achievements in sports & cultural activities / Extra Curricular activities (please

specify accordingly)

YOUR SKILLS IN Expert Average Willing to learn

Handling and use of Audio/Video

Equipment

Operation of OHP System / Laptop

Smart Board

Dispense First Aid

PRO skills /Professional ethics

(dealing with Parents / Teachers)

Assist in Sports and Games

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Form No. Form No. HIS/HRD/NTAF/02/14 – Issue No. 1 Rev. 0 / Mar-14

Any person known to you working in our Yes No
Hindustan Group
If yes, what is his / her name, designation,
department and Institution name and your
relationship

SALARY, ALLOWANCES AND PERQUISITES DRAWN IN THE P.F No. (If

PREVIOUS ORGANISATION (Please give break up) covered)
Salary Allowances Perquisites Total

Gross Salary expected: Joining Time required

REFERENCES (persons not related to you, but knows you for more than a year)
Name, Address & Phone No. Name, Address & Phone No.

Ph: Ph:

(Note: If the space provided is insufficient, pl. attach Annexure along with this form)

I certify that the above information is correct and complete to the best of my knowledge and
belief. If, at any time, I am found to have concealed any material information or even false
information, my appointment shall be liable for summary termination without notice or
compensation. I shall also abide by the rules and regulations of the institution, which are in
force from time to time.

Place:
Date: Signature

INTERVIEW NOTES

Signature of the Interviewer(s)

REMARKS / ORDERS OF APPROVING AUTHORITY

SIGNATURE
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Form No. Form No. HIS/HRD/NTAF/02/14 – Issue No. 1 Rev. 0 / Mar-14