Annexure 16

Candidate Information Form (CIF)

Instructions: Please provide all the information requested in this form. Incomplete Candidate Information
Forms will be returned for completion. All supporting documents must accompany this
form. Legible photocopies are requested please.

PART A - PERSONAL DETAILS:

Full Name (First/Middle/Last)__________ ________________ ___________________

Father’s Name:

Mother’s Name:

Date of birth (DD/MM/YY):______________ Nationality: ___________ __

Residence Number:_____________________ Mobile Number _____ _________

Social Security Number (If worked/studied in the US/Any other Country):

Blood Group: ______________________________________________

Languages Known: ______________________________________________

Personal Email ID: ______________________________________________

Passport No: Issued at: Expires on :

PAN No: ______________________________________________

Date of Joining: ________________

IT Experience Level: _____________________

Non IT Experience Level: _____________________

Total Experience Level: _________________________

FAMILY BACKGROUND (Dependents)

Sl. No Name Relationship Date of Birth

1
2
3
4

Change of Name if Applicable

Former Name/Maiden Name: ____________________________

Date of Name Change: _____________________

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Current Address

Door No/House name: Street: ______________________

City: __________________State:__________________ PIN: _______ ____ _

Period of Stay: _________________

Owner’s Name and Contact Number: (If Applicable)

Permanent Address

Door No/House name: Street: ______________________

City: __________________State:__________________ PIN: _______ ____ _

Landmark: ________________________________

Period of Stay: _________________

Owner’s Name and Contact Number: (If Applicable)

EMERGENCY CONTACT DETAILS

Please provide contact details of two family members and two friends / relatives who do not live with you
SL.No. Name Relationship Mobile Location (City) Email ID
1
2
3
4

Note: Please attach a legible photo copy of any two of following documents:
1. Driving License 2. Passport 3. Ration Card 4. PAN Card 5.Others

DRIVING LICENSE
DL No.
Date of Issue: Valid Till

Address mentioned on DL:

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PART B - LAST EMPLOYMENT DETAILS: (Reverse Chronological Order)

Employment - 1

Name of Company:
Building No & Street:
Company Address
City: State:
(Where you were employed )
Pin:
Period of employment: Employee ID:
Designation & Department: Last Drawn Salary (CTC):

Type of Employment: Permanent [ ] Contractual [ ] Part time [ ] Full Time [ ]

Supervisor’s Name & Designation: Supervisor’s Direct Number & Mail Id:

Can the employer be contacted now? [ ] Yes [ ] No

If not, then provide an alternate date:

Reason for Leaving:

Employment - 2

Name of Company:
Building No & Street:
Company Address
City: State:
(Where you were employed )
Pin:
Period of employment: Employee ID:
Designation & Department: Last Drawn Salary (CTC):

Type of Employment: Permanent [ ] Contractual [ ] Part time [ ] Full Time [ ]

Supervisor’s Name & Designation: Supervisor’s Direct Number & Mail Id:

Can the employer be contacted now? [ ] Yes [ ] No

If not, then provide an alternate date:

Reason for Leaving:

Note: Please attach legible photo copies of the following documents relevant to the entries above.
1) Appointment Letter 2) Salary Slip 3) Relieving Letter

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Employment - 3

Name of Company:
Building No & Street:
Company Address
City: State:
(Where you were employed )
Pin:
Period of employment: Employee ID:
Designation & Department: Last Drawn Salary (CTC):

Type of Employment: Permanent [ ] Contractual [ ] Part time [ ] Full Time [ ]

Supervisor’s Name & Designation: Supervisor’s Direct Number & Mail Id:

Can the employer be contacted now? [ ] Yes [ ] No

If not, then provide an alternate date:

Reason for Leaving:

Note: Please attach legible photo copies of the following documents relevant to the entries above.
1) Appointment Letter 2) Salary Slip 3) Relieving Letter

PART C - REFERENCES

Names of ‘Two people’ who can be used as references to verify your credentials. (Please DO NOT include family
members or friends. References should be college professors / teachers / supervisors / seniors at work, etc…)
1 2
Details
Name
Organization
Designation
How associated / Known to you
Years of association
Contact Landline
Details
Mobile
Address

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PART D –EDUCATION DETAILS:

Post Graduation
Name of the Institute/School/College :
Board/University : Division/Class/% :
Duration of Study (specify month & year): Degree Obtained :

Majored in : Course Type : Regular [ ] Distance [ ]

Student ID/Enrolment/Registration/Roll No :
Building No & Street:

Address of Institute/School/College City: State:

Pin: Landline :

Note: Please attach legible photo copies of the following documents relevant to the entries above.
1) Mark sheets 2) Degree Certificate 3) Provisional Degree Certificate

Graduation
Name of the Institute/School/College :
Board/University : Division/Class/% :
Duration of Study (specify month & year): Degree Obtained :

Majored in : Course Type : Regular [ ] Distance [ ]

Student ID/Enrolment/Registration/Roll No :
Building No & Street:

Address of Institute/School/College City: State:

Pin: Landline :

XII/PUC/Diploma
Name of the Institute/School/College :
Board/University : Division/Class/% :
Duration of Study (specify month & year): Degree Obtained :

Majored in : Course Type : Regular [ ] Distance [ ]

Student ID/Enrolment/Registration/Roll No :
Building No & Street:

Address of Institute/School/College City: State:

Pin: Landline :

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X
Name of the Institute/School/College :
Board/University : Division/Class/% :
Duration of Study (specify month & year): Degree Obtained :

Majored in : Course Type : Regular [ ] Distance [ ]

Student ID/Enrolment/Registration/Roll No :
Building No & Street:

Address of Institute/School/College City: State:

Pin: Landline :

Note: Please attach legible photo copies of the following documents relevant to the entries above.
1) Mark sheets 2) Degree Certificate 3) Provisional Degree Certificate

PART E - MISCELLANEOUS
Please tick the appropriate answers.

Have you ever been convicted for felony or any serious crime? Yes/No

If the answer is ‘Yes’, please provide details on a separate sheet of paper.

Have you ever been “Laid off” or Terminated from employment? Yes/No

If the answer is ‘Yes’ please provide details below:

Certification by Candidate

I certify that the information provided in this form is true and correct to the best of my knowledge.

I further certify that I have furnished the answers in Part ‘E’ on my own accord, free of any duress.

I authorize ‘Attra Infotech’ or its agency to verify my credentials.

I understand that if any information furnished by me is found to be false, I could be denied employment/be
terminated.

I will cooperate and facilitate the process of verification of my credentials.

Place:
Date: Signature of the Candidate/Employee

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