For office use

Code
1. This form is to be filled by candidate only Date(MM/DD/YY
2. Please attach photocopies of all relevant certificates to )
the extent possible.
Have you ever been interviewed before at ABC
Company YES ( ) NO ( )
If Yes, then answer the following:
Date of pervious
interview
Division Applied for
Interviewer

Post applied Division Date of

for Interview

Personal Details:
Name in full (BLOCK LETTERS) : Mr./Ms./Mrs. :

Surname : First name: Middle name :

Email :

Present Address : Permanent Address :

Landline No. Landline No :

Mobil
0
e No.
Signature:
Emergency Contact No. :

Date of Birth Age Height

Place of Birth
Sex Weight
Physical Handicap if any:
State Religion
Caste Major / Minor Eye sight:
Nationality surgery in past
Blood :
Group

Major illness/disease in last three years :

FAMILY DETAILS :
Marital Status (√ mark the applicable) : ( ) Single ( ) Married ( ) Widow ( ) Widower ( )
Divorcee

Name Date of Age Occupation Income

Birth (Per Annum)
1 Spouse

2 Children (if any)

(1)

(2)
3 Father

4 Mother

5 Brother / Sister

6 Other family
member/s

Details of Educational Qualification : (Descending Order)

Sr.No Examination Cleared School / College Class / % of Subjects Year of passing
. / University Division Marks
1

Note: Furnish exact details of any drop in your Educational career e.g Failure, non appearance etc.
Particulars of special training under
gone
Any Visit abroad?
If so, give details
Do you posses a passport? If Number Validity
any, provide details
Do you own a two / four Driving Validity
wheeler? If any, provide license No.
details

Languages Known
Language Speak Read Write Understand only
 Computer Proficiency Certificate Available (Put √)

Sr.No YES NO
1

Details of Present Employer

Name of
Organization
Designation Address :

Job Profile
(Mandatory)

Details of work experience :( Descending order)

Sr.No. Name of the Designation Period of Last salary Commercial
Organization Employment drawn reference /
From To (Total Telephone No.
mm/yy mm/yy Package)
1

10
Indicate your professional and personal : (Mandatory)
Sr.N Strengths Area/s of Improvement
o
1

Why do you consider yourself suitable for this position? (Kindly justify…)

Any past prosecutions or current legal proceeding YES NO

If yes, give details.

Kindly give references :

Sr.N Name Occupation Address & Phone No.
o.
Personal
1

Professional
1

3
 Salary Heads
(A) Monthly Present CTC Expected CTC Final CTC
1 Basic
2 HRA
3 Children’s Education
4 Tea / Snacks
5 Uniform / Attire
6 Special
7 Magazine
8 Transportation
9 Any Other (1)
(2)
Total (A)
(B) YEARLY
1 Medical Reimbursement
2 LTA
3 Bonus
4 Any other (1)
(2)
Total (B)
(C) OTHER
1 PF
2 Gratuity
3 ESI
4 Any other (1)
(2)
Total (C)
(D) BENEFITS
1 Mobile
2 Car
3 Laptop
4 Driver
5 Any other (1)
(2)
Total (D)
Total A + B + C + D
Designation
Hereby, I declare that the information provided is true as per my best belief and knowledge. At any stage if
any information provided by me is found incorrect or suppressed, my appointment is liable to be
terminated with immediate effect without any notice or any payment in lieu of notice.

Signature of Candidate: Remarks if any: (For Office Use only):

Date :

Above offer is mutually accepted and agreed (Post Selection)

Signature of the Candidate:

Date:
DRAW YOUR DIVISONAL/DEPARTMENTAL ORGANOGRAM SPECIFYING YOUR POSITION

FOR OFFICE USE ONLY TO BE FILLED BY FINAL INTERVIEWER, IF APPOINTED

Name : Designation :

Department : Function :

Division : CTC Offered (P.M) :

Place of Posting : Probation Period :

Date of Joining : Reporting to :

Date of submission of SD: Date of issue Apt Letter :

Benefit Offered : Sign of Head SBU :

Signature of Head HR : Sign of Director :

Please write Job Code as a subject line and send this Application form to