Kalpataru

Applicant Information Sheet

Personal Details

Name of the Applicant *

First Middle Last Name

Date of Birth (DD/MM/YYYY) *

Father’s Name

PAN Number or SSN for US*

Permanent Address
& Duration of Stay *
Telephone *
Mobile *

Current Address *
& Duration of Stay
Telephone *
Mobile *

Previous Address *
& Duration of Stay
Telephone *
Mobile *

Client Employee Code *

Whether to Contact the Current Yes If Not, Then After What Date:
Employer *

Please Note: Fields marked with astrix are absolutely mandatory.

Education History (Highest Degree Qualification)

Name of the Institute / College *

Location (City, State) *

Affiliated University *

Contact Details

Qualification (Type of Degree) *

Specialization (Major Subject) *

Dates Attended (DD/MM/YYYY) * Start date and year of passing

Exam Seat No / Registration

Number / Enrollment No *

Marks Obtained / Class Obtained *

Documents Required: Copy of Degree Certificate & Final Year Marksheet *

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 Employment History (Most Recent)
Employer 1 *
{Provide Agency Details if on Contract}

Location (City, State) *

Contact Details *

Employee Code * (If applicable)

Dates of Employment * Start: End:

(DD MM YYYY)

Designation *

Last Salary Drawn (CTC) *

Reason for Leaving *

Reporting Manager *

HR Manager

Employer 2 *
{Provide Agency Details if on Contract}

Location (City, State) *

Contact Details *

Employee Code * (If applicable)

Dates of Employment* Start: End:

(DD MM YYYY)

Designation *

Last Salary Drawn (CTC) *

Reason for Leaving *

Reporting Manager *

HR Manager

Employer 3 *
{Provide Agency Details if on Contract}

Location (City, State) *

Contact Details *

Employee Code * (If applicable)

Dates of Employment* Start: End:

(DD MM YYYY)

Designation *

Last Salary Drawn (CTC) *

Reason for Leaving *

Reporting Manager *

HR Manager

Documents Required: Copy of Relieving Letter (Preferred) or Experience Certificate

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 Integrity Details

Whether you have been convicted Yes No

in the past of issues relating to Anti-
Bribery; Anti-Corruption; Fraud;
Collusion; anti-competitive activity;
coercive practices or any other
If yes, please provide details and supportings (Eg: Court order)
integrity related issue.
Whether any disciplinary actions Yes No
(eg: warnings, fine, penalty,
termination) has been taken against
you in previous organization for
above listed related issues? If yes, please provide details and supportings

Have you given or accepted bribe in Yes No

the past?

If yes, please provide details

Details of any past allegations on

you in relation to above listed issues
which were not sustained.

DECLARATION

I, confirm that all the above information is true and correct and that no information has been
suppressed or misrepresented. In case any information is found to be inadequate, I shall be
liable for discliplinary actions as per policies of the Company.

Signature:
Name of Applicant:
Date:
Place:
APPLICANT AUTHORIZATION

I hereby authorize Kalpataru Limited and the appointed agencies to Verify information provided in my resume and
the applicant Information sheet for employment purposes and to conduct enquiries necessary.

I authorize all who may have pertaining information relevant to this enquiry to disclose the same.

Thank you.

Full Name: ____________________________________________ Place: _____________

Signature: _____________________________________________Date: ______________

DOCUMENTS CHECKLIST:

1. Completed & Signed Application Form

2. Relevant Education Certificates (Degree Certificate & Final Year Marksheet)
3. Experience Certificate or Relieving Certificate
4. Proof of Address & Identity: Government issued ID, or Passport Copy or Pan Card

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