CANDIDATE APPLICATION FORM

Salutation First Name Middle Name Last Name

Name as per Adhaar
Card

Father's Name Gender DOB ( DD/MM/YYYY) Contact Number

PAN Email_Id Have you ever been interviewed in Care Health Insurance in last 6 months? - Yes/No
If Yes, Where and for which role? __________________________________
Who was the Interviewer? ________________________________________

Permanent Address Current Address Same as Permanent Address (Yes/No)

Line 1 Line 1
Line 2 Line 2
Line 3 Line 3
Line 4 Line 4
State Pin Code State Pin Code
Country Country

Internet / WiFI/ Dongal availiablity Yes No

Employment Details
Reporting Reporting Employment
Employment Employment
Employment Manager - Manager's Type: Full/
Name of the Organization Last Designation Start Date End Date Last CTC Emp_code
Details Name & Contact Part Time/
(DD/MMM/YYY) (DD/MMM/YYY)
Designation number Contract
Current / Last
Employer
2nd Last
Employer
3rd Last
Employer
 CANDIDATE APPLICATION FORM

Education Details

Degree College/ Institute

Qualification University Year of Joining Year of Passing Full time/ Part Time Grade/ Percentage
Name Name

10th

12th

Graduation

Post-
Graduation

Do you have any family member /relative working with Care Health Insurance or any group company (Yes/No) _______________________________________________________

If Yes, please mention the name and department ________________________________________

Have you been vaccinated (Yes/No), If No please specify the reason _______________________________________________________

Covishiel Covaxi
Vaccination Name d n
If yes please specify the

Undertaking:
Terms and Conditions: Terms and Conditions: I certify that the information furnished above is factually correct and subject to verification by the company (including Reference Check &
Background Verification). I accept that an appointment given to me on this basis can be revoked and/or terminated without any notice at any time in future if any information has been false,
misleading or deliberately omitted/suppressed. I also certify that I am at present in sound mental and physical condition to undertake employment with the company.

Signatur
Date e

Place