EMPLOYMENT APPLICATION FORM

POST APPLIED FOR: Scrum Master

FULL NAME IN BLOCK LETTERS

SHIRAVADEKAR AMIT ANIL

(LAST) (FIRST) (MIDDLE) PLEASE AFFIX

YOUR RECENT
PASSPORT SIZE
PRESENT HOME MAILING ADDRESS: BALAJI RESIDENCY MADHUBAN COLONY PHOTOGRAPH

LANE NO 5 , 205 SECOND FLOOR OLD SANGVI PUNE 411027

PIN CODE 411027

TELEPHONE (With Code) CELL: 9960111658

E-MAIL : AMIETSHIRAVADEKAR@GMAIL.COM BIRTH DATE [DD/MM/YYYY]

PERMANENT HOME MAILING ADDRESS: RENURAJ APARTMENT 1770 A WARD 10/11/1989

SAKOLI CORNER NEAR ADARSH VIDYALAYA KOLHAPUR 416012 AGE (YRS) 33

PIN CODE 416012 BIRTH PLACE

TELEPHONE (With Code) CELL: 9322832341 SANGLI

MARRIAGE DATE
GENDER MARITAL STATUS NATIVE STATE RELIGION NATIONALITY STATE OF DOMICILE
(If Married)

M MARRIED 12TH MAY 2018 MAHARASHTRA HINDU INDIAN MAHARASHTRA

PERSONAL DATA

CASTE SC ST DT NT SBC OBC ✘ GEN.CAT [Other than GEN.CAT please arrange to produce Caste Certificate]

LANGUAGES KNOWN (Including Foreign) SPEAK READ WRITE PASSPORT NO. P4409485

ENGLISH ✘ ✘ ✘ PASSPORT ISSUE DATE 12/29/2016

HINDI ✘ ✘ ✘ VALID UPTO DATE 12/28/2026

MARATHI ✘ ✘ ✘ COUNTRY OF ISSUE INDIA

VALID VISA DETAILS NA

PAN NUMBER DSZPS2866G

DETAILS OF FAMILY MEMBERS (parents, spouse, children, siblings & any other dependents excluding self)

NAME RELATIONSHIP DATE OF BIRTH QUALIFICATION OCCUPATION ORGANIZATION AND POSITION

ANIL RAMACHANDRA SHIRAVADEKAR Father 26TH JULY 1960 SHOPKEEPER NA NA

RAJASHREE ANIL SHIRAVADEKAR Mother 9TH JUNE 1967 HOMEMAKER NA NA

PRADNYA RAVEENDRA KULKARNI WIFE 27TH APRIL 1990 BCA GOV SERVENT NA

EMERGENCY CONTACT DETAILS NAME RAJASHREE ANIL SHIRAVADEKAR

ADDRESS RENURAJ APARTMENT SAKOLI CORNER KOLHAPUR

RELATION MOTHER TELEPHONE NO. 8624019871

HEALTH DATA

HEIGHT (cms) WEIGHT (kg) BLOOD GROUP EYESIGHT [SPECIFY POWER IF WEARING GLASSES/LENSES] PHYSICAL DISABILITY (IF ANY)

NO
167 76 O POSITIVE Right Left

1
 HEALTH DAT
NO

NA
IDENTIFICATION MARKS

EDUCATION
WHETHER DURATION OF MONTH & DISTINCTIONS /
SPECIALISATI SCHOOL / COLLEGE / UNIVERSITY/ FULLTIME / GRADE %
EXAMINATION PASSED PARTTIME/
COURSE YEAR OF SCHOLARSHIPS / PRIZES
ON INSTITUTION BOARD MARKS
CORRES. (Yrs & Mths) PASSING WON

SSC OR Equivalent S M LOHIA HIGHSCHOOL MAHARASHT

School leaving Certificate
SSC FULLTIME 1 YEAR 2005 83.2 DISTINCTION
KOLHAPUR RA STATE

Intermediate or
12th standard / HSC

DIPLOMA IN DIPLOMA IN GOVERNMENT

AUTONOMO
INFORMATION INFORMATION POLYTECHNIC FULLTIME 3 YEARS 2008 77.19 DISTINCTION
DIPLOMA

US
TECHNOLOGY TECHNOLOGY KOLHAPUR

D Y PATIL COLLEGE OF
COMPUTER SHIVAJI
BE COMPUTERS ENGINEERING AND FULLTIME 3 YEARS 2011 67.13 DISTINCTION
ENGINEERING UNIVERSITY
TECHNOLOGY
DEGREE (S)
POST. GRAD. DEGREE /
DIP. CERTIFICATE

MEMBERSHIP OF PROFESSIONAL INSTITUTE

DURATION OF MEMBERSHIP
NAME OF INSTITUTE TYPE OF MEMBERSHIP AND POSITION HELD
PERIOD FROM TO

TRAINING / CERTIFICATIONS
WHETHER CERTIFICATE
NAME OF THE TRAINING COURSE DURATION YEAR INSTITUTE / ORGANISATION
AWARDED

PSM 1 NA 2021 SCRUM.ORG YES

PSM 2 NA 2022 SCRUM.ORG YES

ITIL V4 NA 2021 PEOPLESOT YES

PAPERS PUBLISHED / PRESENTED

TITLE NAME & DATE OF THE SEMINAR / JOURNAL IN WHICH PRESENTED / PUBLISHED

EXTRA CURRICULAR ACTIVITY (E.G. Sports, Social & Literary activities etc.)
ACTIVITY INSTITUTION/ASSOCIATION/SOCIETY/CLUB YEAR POSITION HELD PRIZES WON

SKILLS SUMMARY
(Give brief details for the projects you have worked on)
PROJECT TITLE ROLE TEAM SIZE DURATION LANGUAGE / PLATFORM / OS

2
ORACLE CERNER HEALTHCARE SR SCRUM MASTER 10 + 10 2 YEARS JAVA SQL

POSTI OY TECHNICAL LEAD CUM SCRUM MASTER 9 3.8 YEARS ORACLE PLSQL

WORK EXPERIENCE
In unbroken chronological order starting from your present employment and ending with first employment
(Please account for all the periods of time not covered by education / training) [Please attach extra sheet if required]
EMPLOYER'S NAME DURATION
LAST POSITION HELD DESIGNATION NATURE OF DUTIES
& ADDRESS PERIOD(Yrs.)
2 SCRUM MASTER WORK
SCRUM MASTER
FROM

WIPRO LIMITED PUNE 12/6/2021 NAME & DESIGNATION OF IMMEDIATE SUPERIOR

Plot No.31 MIDC, TO
Hinjawadi Phase 2 Rd, RAJDEEPAN
Hinjawadi Rajiv Gandhi Feb-21
Infotech Park,
Hinjawadi, Pune, GROSS EMOLUMENTS Rs. AT THE TIME OF JOINING 26 LPA LAST DRAWN
Maharashtra 411057 Per month 26 LPA
BASIC (P.M.) FIXED (P.A.) VARIABLE (P.A.) GROSS (P.A.)
Details of Current
Emoluments 24 LPA 2 LPA 26 LPA
EMPLOYER'S NAME DURATION
LAST POSITION HELD DESIGNATION NATURE OF DUTIES
& ADDRESS PERIOD(Yrs.)
3.9 YEARS TECHNOLOGY LEAD WORK PLUS PROJECT
TECHNOLOGY LEAD MANAGEMENT AND SCRUM WORK
INfOSYS LIMITED,Plot FROM
No. 1, Hinjawadi Phase
II, Hinjawadi Rajiv Feb-18 NAME & DESIGNATION OF IMMEDIATE SUPERIOR
Gandhi Infotech Park, TO
Hinjawadi, Pune, PRATHYUSH Y
Pimpri-Chinchwad, Nov-21
Maharashtra 411057
GROSS EMOLUMENTS Rs. AT THE TIME OF JOINING 8.5 LPA LAST DRAWN
Per month 10 LPA
EMPLOYER'S NAME DURATION
LAST POSITION HELD DESIGNATION NATURE OF DUTIES
& ADDRESS PERIOD(Yrs.)
2 YEARS SQL AND PL SQL DEVELOPMENT WORK AND
TECH MAHINDRA SR SOTWARE ENGINEER DATABASE WORK
LIMITED,JP38+FFG, FROM
Hinjawadi Phase II, Mar-16 NAME & DESIGNATION OF IMMEDIATE SUPERIOR
Hinjewadi Rajiv Gandhi
Infotech Park, TO
Hinjawadi, Pimpri- KARBHARI HANDE
Feb-18
Chinchwad,
Maharashtra 411057 GROSS EMOLUMENTS Rs. AT THE TIME OF JOINING 5.5 LAST DRAWN
Per month 5.5
EMPLOYER'S NAME DURATION
LAST POSITION HELD DESIGNATION NATURE OF DUTIES
& ADDRESS PERIOD(Yrs.)
1.7 PROCESS ANALYST AND DATABASE DEVELOPMENT
PROCESS ANALYST WORK
FROM
BISIL PUNE,C/102/11,
Pune IT Park Sep-14 NAME & DESIGNATION OF IMMEDIATE SUPERIOR
34, Aundh Road TO
Bhau Patil Marg, Pune – SAVITA PATHAK
411 020 Feb-16

GROSS EMOLUMENTS Rs. AT THE TIME OF JOINING LAST DRAWN

Per month

EMPLOYER'S NAME DURATION

LAST POSITION HELD DESIGNATION NATURE OF DUTIES
& ADDRESS PERIOD(Yrs.)
CONTRACT ENGINEER
CONTRACT ENGINEER
FROM
Oct-11 NAME & DESIGNATION OF IMMEDIATE SUPERIOR
BHARAT ELECTRONICS
LIMITED BANGLORE TO
CONTRACT ENGINEER
Aug-13

GROSS EMOLUMENTS Rs. AT THE TIME OF JOINING LAST DRAWN

Per month

EMPLOYER'S NAME DURATION

LAST POSITION HELD DESIGNATION NATURE OF DUTIES
& ADDRESS PERIOD(Yrs.)

3
 FROM
NAME & DESIGNATION OF IMMEDIATE SUPERIOR
TO

GROSS EMOLUMENTS Rs. AT THE TIME OF JOINING LAST DRAWN

Per month

DRAW IN BRIEF THE ORGANISATION STRUCTURE OF THE COMPANY WHERE YOU ARE PRESENTLY EMPLOYED INDICATING TWO
LEVELS ABOVE AND ONE LEVEL BELOW YOUR POSITION (PLEASE ALSO INDICATE THE TOTAL NUMBER OF PERSONS UNDER YOU)
CURRENTLY I AM IN TO SCRUM /DEVOPS PRACTICE WHICH IS SPECIALIZED PRACTICE AGILE ENGINEERS

WHAT ARE YOUR SIGNIFICANT ACHIEVEMENTS AND EXPLAIN WHY YOU CONSIDER YOURSELF SUITED FOR THE POSITION :
BECAUSE ALL I AM HAVING TECHNICAL AS WELL AS SCRUM MASTER ROLE WHICH IS VERY SUITABLE TO POSITION APPLIED

HAVE YOU EVER BEEN INTERVIEWED BY ANY OF THE L&T GROUP OF COMPANIES?
YES NO DATE/YEAR POSITION COMPANY
If Yes, give
✘
details

RELATIVES / ACQUAINTANCE IN L&T GROUP OF COMPANIES

NAME RELATIONSHIP POSITION COMPANY & TELEPHONE NOS.
GENERAL DATA

HOW DID YOU COME TO KNOW OF THIS POSITION? DIRECTLY HR CONTACTED

ARE YOU ENGAGED IN ANY PERSONAL BUSINESS ? if YES,

indicate nature of
YES NO ✘ business

DO YOU HAVE ANY CONTRACT / BOND

WITH YOUR PRESENT EMPLOYER? if YES,
Give Details
YES NO ✘

IF SELECTED, WHEN CAN YOU JOIN? Mar-23

NAME, ADD., AND TEL Nos. OF TWO SUPERIORS FAMILIAR WITH YOUR WORK (NOT RELATIVES)
NAME COMPANY & POSITION TELEPHONE NOS. E-MAIL ID
MONA VYAS WIPRO LIMITED 9558816328 DRMONA.VYAS89@GMAIL.COM

KARBHARI HANDE TECH MAHINDRA (EX) 9766663765 KARBHARI_HANDE1981@YAHOO

HAVE YOU EVER BEEN INVOLVED IN ANY CRIMINAL PROCEEDINGS / CONVICTED OF ANY OFFENCE? IF YES, GIVE DETAILS
CRIMINAL
RECORD

NO

DECLARATION UNDER SECTION 314 OF COMPANIES ACT, AS AMENDED IN 1974 (Tick whichever is applicable)
I hereby declare that I am not connected with any of the Directors of the Company as his partner or his relative as defined under section 6 of ✘
the Companies Act 1956

4
 OR
I hereby declare that I am a partner or relative of a Director of the Company
✘
as .

I declare that the information given above is true to the best of my knowledge. I am aware that any false or incorrect information by me may result in
termination of my service with the Company. I have no objection to your inquiring from any of my previous employers on any matters pertaining to me, if I join
your Company.

PLACE PUNE DATE 2/14/2024 Applicant's Signature