YES NO

AGE
ISSUE
DATE
EXPIRY
DATE
ISSUED AT ECNR ECR
YEAR GRADE
FROM TO
POSITION SELECTED
REMARKS
Tel : + 91 22 26747160 / 65 / 70 fax + 91 22 26731878 email : indman@indman.com
LICENCE # 3173 / MUM / PER / 1000+ / 3 / 5268 / 99
BAR CODE
PASSPORT DETAILS
TITLE
Plot # 8, Shah Industrial Estate, Off Veera Desai Road. Andheri (W), Mumbai - 400 053.
PERSONAL APPLICATION
PASTE PHOTO HERE
NAME AS PER PASSPORT
CALLED ON
INTV. ON
ENTRY DATE
REQUIREMENT REF SALARY EXPECTED
SALARY OFFERED CLIENT / AREA / PROJECT
EMPLOYMENT RECORDS
SOFTWARES USED
EMPLOYERS
COMPUTER KNOWLEDGE
GIVE DESCRIPTION OF DUTIES, RESPONSIBILITIES AND EQUIPMENTS USED -
PLEASE FILL IN THE COMPLETE DETAILS IN PRINT AND ATTACH PHOTOCOPIES OF
CREDENTIALS AND REFERENCES
RELIGION CASTE DATE OF BIRTH PLACE OF BIRTH
SALARY
DETAILS
FATHERS NAME
DEGREE / DIPLOMA / OTHERS*
FOR OFFICE USE ONLY
TEST
UNIVERSITY / INSTITUTE
EDUCATIONAL / TECHNICAL QUALIFICATIONS & CERTIFICATIONS
POSITION APPLIED
SECOND CHOICE
MOTHERS NAME
NO. OF CHILDREN
SALARY EXPECTED
PASSPORT NUMBER
SPOUSE NAME
NOTICE PERIOD REQUIRED TO JOIN ?
FROM TO
READ WRITE SPEAK ISSUE DT. EXP. DT.
TEL. NO.
MAY WE CONTACT YOUR PRESENT EMPLOYER NOW WITHOUT JEOPARDIZING YOUR POSITION ?
ADDITIONAL EXPERIENCE DETAILS
EMPLOYERS TITLE SALARY
GIVE DESCRIPTION OF DUTIES, RESPONSIBILITIES AND EQUIPMENTS USED
COUNTRY OF LISC. ORIGINAL / COPY
L.M.V.
KNOWLEDGE OF LANGUAGES
INDICATE GOOD OR FAIR DRIVERS & OPERATORS
TYPE OF LICENCE/S
EQUIP. CAPACITY CAPACITY LIFTED DETAILS
H.M.V.
PLEASE READ CAREFULLY
APPLICANT'S CERTIFICATION AND AGREEMENT
3) I UNDERSTAND THAT ANY MISREPRESENTATION OR MATERIAL OMISSION MADE ON THIS FORM OR ANY OTHER RELEVANT DOCUMENTS, TENDERS ME LIABLE TO
DISMISSAL WITHOUT NOTICE AND I HEREBY WAIVE ALL MY RIGHT RECOURSE.
PRESENT ADDRESS
I) I HEREBY CERTIFY THAT THE ANSWERS GIVEN AND STATEMENTS MADE ARE TRUE AND CORRECT. IHEREBY AUTHORIZE ALL MY PREVIOUS EMPLOYERS AND
REFERENCE TO FURNISH ANY INFORMATION CONCERNING MY PERSONAL CHARACTER, HABITS AND EMPLOYMENT RECORDS.
2) I AM SUBMITTING HEREWITH MY ORIGINAL PASSPORT WITH INDMAN CONSULTANTS BY AUTHORIZING THEM TO PROCESS MY OVERSEAS EMPLOYMENT VISA AND
OTHER RELATED TRAVEL DOCUMNTS AS PER AGREED TERMS. I AGREE TO REIMBURSE THE EXPENSES INCURRED BY INDMAN CONSULTANTS TOWARDS PROCESSING
OF MY TRAVEL DOCUMENTS IF I WITHDRAW MY DOCUMENTS AFTER PROCESSING MY VISA.
HAVE YOU EVER BEEN ARRESTED OR CONVICTED OF A FELONY? IF YES, PLEASE GIVE FULL DETAILS-
NAME AND CONTACT NO. IN CASE OF EMERGENCY
PERMANENT ADDRESS
4) I UNDERSTAND THAT INFORMATION AND ANY DOCUMENTS PROVIDED IS WITHOUT OBLIGATION TO INDMAN CONSULTANTS OR TO THEIR PRINCIPAL ARE NOT
RETURNABLE.
EQUIPMENT OPERATORS PLEASE SPECIFY EQUIPMENT USED / OPERATED
MAKE OF EQUIPMENT USED MODEL NO.
EMAIL TEL. NO.
DATE APPLICANTS SIGNATURE
MOBILE No.