APPLICATION FORM FOR EMPLOYMENT

POSITION: Ref No

PERSONAL DETAILS
FULL NAME First Name Middle Name Surname
(IN BLOCK CAPITALS)

ADDRESS PRESENT: PERMANENT/ NATIVE:

(IN BLOCK
CAPITALS)

Date of Birth Age Contact Telephone Nos.

Day Month Year Year/Month Res/ PP Mobile Office

E Mail: 1. Affix recent

passport size colour
2. photograph
Height
(Cms)
Weight
(Kgs) Details of valid Passport and Driving License, if any: -
Date of Place of Valid
Blood Number Countries Visited
Issue Issue up to
Group
Passport
Marital
Status Driving
License

EDUCATIONAL BACKGROUND
SSC/ HSC/ Diploma/ Main subjects of Year Name of School/ Name of Class/
Degree study of College/ University %
Additional Course Stream/ Medium: passin Institute and Place Affiliated Marks
(In chronological order) English/ g Award
Vernacular

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SSC/ HSC/ Diploma/ Main subjects of Year Name of School/ Name of Class/
Degree study of College/ University %
Additional Course Stream/ Medium: passin Institute and Place Affiliated Marks
(In chronological order) English/ g Award
Vernacular

PRESENT EMPLOYMENT

Name of Employer

Address of Organisation

Date of Joining

Brief description of present

job; Highlight special
achievements,
Award, promotions, etc

Applicant for position of Asst

Manager or above should
draw a brief organisation
chart here denoting his/ her,
positions, which report to
him/ her, and positions, which
he/ she reports to
(Designations only)

Details of present emoluments Head of Total

Basic HRA
Salary Monthly
(Monthly) Monthl
y
Amount
Other emoluments like PF,
LTA, Medical, Gratuity,
Bonus/ Ex-gratia etc

Any benefits/ facilities in

kind?

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Expected salary from ROLTA
Apart from monthly salary
ROLTA pays
a) PF contribution
b) Bonus/ ex-gratia as
declared
In addition to these, what
gross monthly salary you
expect?

What notice period do you

need to join?

PREVIOUS EMPLOYMENT (Reverse chronological order)

Period Organisation Monthly Brief

Total
From To Name, brief Designation emoluments Description of
Exp
(Date) (Date Address (Last) Job

EXPERIENCE OVERALL RELEVANT

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 Note a. Experienced software applicant should attach additional sheets describing software projects
: handled by them covering information regarding:
Project name, project size, team size, customer, candidate’s role. HW/ SW used, project
brief and duration etc. for each project handled.
b. Applicants for other than software/ hardware jobs may indicate their exposure to computer
e.g. PC’s packages, etc. in job description above

FAMILY BACKGROUND

ROLTA is concerned about family background of its employees. Further, on special occasions, especially in
case of emergency, it is necessary to know details about such relations. We consider Father, Uncle (father’s
brother), brothers, brother-in-law as relations close enough for this purpose. Wherever relevant, please give
details of these relations in the following space:

1. Father 2. Real Uncle (father’s brother)

a. Name: a. Name:
Occupation: Occupation:
Contact Telephone Contact Telephone
No: No:
Address: Address:

3. Brother
a. Name: a. Name:
Occupation: Occupation:
Contact Telephone Contact Telephone
No: No:
Address: Address:

4. Brother-in-Law 5. Spouse
a. Name: a. Name:
Occupation: Occupation:
Contact Telephone Contact Telephone
No: No:
Address: Address:

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If none of the above is relevant, please mention other close relations below:

a. Name: a. Name:
Relationship: Relationship:
Occupation: Occupation:
Contact Telephone Contact Telephone
No: No:
Address: Address:

ADDITIONAL INFORMATION

a. Please mention any special information which you think could influence us in your favour.

b. Languages Known: Fluent

(Underline Mother tongue) Working
knowledge
c. What are your leisure activities?

d. Mention any memberships, clubs, organisations.

e. Any of your relations working with ROLTA, now or earlier? Give details.

f. Your State of health: mention any physical handicap, surgical treatment undergone or any illness during
last 2 years requiring more than 10 days out of work

g. Entrants joining ROLTA for position below Senior Executive grade are expected to sign a Service
Agreement to serve ROLTA for minimum period of two years. Are you ready to sign such agreement?

h. Are you willing to be posted anywhere, in India or abroad? Any preference of place?

i. Have you applied for any position in ROLTA prior to this?

I hereby declare that the information given in this form is true and correct to the best of my knowledge.

I hereby affirm that the facts/ figures enumerated herein are true and that I have withheld nothing which
could affect my employment with the company.

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In case any information given by me concerning my appointment is found to be false or incorrect, my
services are liable to be terminated without any notice.

Dat Name Signature

e

REFERENCES:

Though ROLTA elicits relevant information about Candidates during interviews, it is necessary to check
third party options. As a routine, therefore, ROLTA checks about the prospective employee from references
mentioned by the candidate. Both type of references, viz. those who know you socially and those who know
you professionally are required. Processional references should preferably be from your earlier
employment. Mention only those which could be contacted without further reference to you.
(In the last column mention S against those who know you only socially; P against those who know you
professionally, such as those from earlier organization; and SP against those who know you socially as well
as professionally. There should be a proper mix of S and p)

No Name/Designation/Organisation Tel No. Email Id Address for S/P/SP

Communication
1

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