Employment Application Form

If you have already registered on our IBM Job Portal please provide the IBM Candidate Applicant ID also called GOM
Candidate Applicant ID. If you are referred by an Agency, please ask your agency for the Applicant ID

IBM Application ID *

C
Please affix your passport size photo here

FILL ALL DETAILS IN CAPITAL LETTERS

*Title
* Enter your name as per your Passport, Driver's Licence, PAN Card or Or any Govt issued Photo Identity card (For Indian
Nationals)

*First Name / Given Name

Middle Name

*Last Name / Family Name

Father's Name

*Date of Birth

*Mobile Number

DD

MMM

YYYY

Country Code

*Personal Email ID

Mobile Number

Telephone (Landline)
Country Code

PAN Card

Passport Number

Place of Issue of Passport

Expiry Date
DD

*Nationality

Country Of Birth

City Code

MMM

YYYY

City Of Birth

*SOURCE INFORMATION - How did you know about this vacancy in IBM? (Select any one of the below)
Agency
Employee
Referral

Enter Agency name

Name of the Employee
(Referrer Name)

Referrer's employee
Number

Referrer's E- Mail ID
Job Site

Enter the jobsite name

here

Direct
Page 1 of 8, Employment Application form V 02, wef - 11th May 2015

Phone Number

Social Networks (Website

Name -Facebook/ LinkedIn/
Twitter/ Google+)

EDUCATION DETAILS (Fill in CAPITAL Letters)

Please complete all fields, even if you have already provided a resume. Provide details on COMPLETED degree programs only.
*Highest Qualification (Completed)

** e.g.: M.Sc, B.Com

**Highest completed degree / diploma awarded by a University / Board or its affiliates and or approved by UGC / AICTE / Ministry of HRD / Government of India

Qualification

Complete Name & Address of School / College / Institution and

Name of the University
*University name is mandatory where applicable(DO NOT ABBREVIATE)

Course Tenure

MMM

YYYY

Start Date
SSLC (10th)

End Date
Year Of Passing

University
Details (Name
& Address) if
applicable

MMM

YYYY

Start Date
HSLC (12th)

End Date
Year Of Passing

School/
College/
Institution
details (Name
& Address

University
Details (Name
& Address) if
applicable

MMM

YYYY

Start Date
Graduation

School/
College/
Institution
details (Name
& Address

End Date
Year Of Passing

School/
College/
Institution
details (Name
& Address

University
Details (Name
& Address) if
applicable

MMM

YYYY

Start Date
Post Graduation End Date
Year Of Passing

Page 2 of 8, Employment Application form V 02, wef - 11th May 2015

School/
College/
Institution
details (Name
& Address

University
Details (Name
& Address) if
applicable

Percentage/
Grade Points

Registration /
Roll / Final
Year Seat
Number

Name of the
Degree
Awarded
(e.g.. B.com /
BA/ Mtech)

EDUCATION DETAILS - contd. (Fill in CAPITAL Letters)

Qualification

Complete Name & Address of School / College / Institution and

Name of the University
*University name is mandatory where applicable(DO NOT ABBREVIATE)

Course Tenure

M M M Y Y Y Y
Start Date
Others - PhD,
Additional
Degrees

Percentage/
Grade Points

Registration /
Roll / Final
Year Seat
Number

Name of the
Degree
Awarded
(e.g.. B.com /
BA/ Mtech)

School/
College/
Institution
details (Name
& Address

End Date
Year Of Passing

University
Details (Name
& Address) if
applicable

State reasons for GAP in education, if any :

Professional Training (includes in progress degrees) - please mention the details

*Have you worked for IBM earlier?

BUSINESS UNIT

Yes
DATE OF
JOINING

LOCATION

(DD-MMM-YYYY)

*Are you willing to relocate as part of

your employment with IBM?

Yes

No

If "YES", please provide following details:

LAST WORKING DAY

(DD-MMM-YYYY)

No

TYPE OF EMPLOYMENT
(Regular/FTH/Contractor)

MANAGER'S NAME

If yes, please indicate

your preferences

*Consistent with IBM's policy on workforce diversity and in order to accommodate employee's special
needs in the work environment, please indicate if you are physically challenged

Yes

No

** IBM Corporation is an Equal Employment Opportunity Employer

If yes, please provide description of disability and

accommodation / assistance required:

*Do you have any non-compete obligations or conflict situations or other restrictive clauses with any party
including any of your previous employers that prevent you from working for IBM India Private Limited?
Page 3 of 8, Employment Application form V 02, wef - 11th May 2015

EMPLOYEE NUMBER/
CONTRACTOR CODE

Yes

No

EMPLOYMENT HISTORY (FILL IN CAPITAL LETTERS)

Provide your last 3 (three) employment history. Also include information on self-employment. You can leave this page blank if you do not have prior work experience.

Serial
No
Organisation Name

01

02

03

Employment Type
(Permanent
/Contractual)

Organisation Name and address

*Most Recent

Tenure

Employee Number

Full Time / Part

Time

Start Date

Address along with PIN Code

End Date

Organisation Name

Start Date

Address along with PIN Code

End Date

Organisation Name

Start Date

Address along with PIN Code

End Date

Below is continuation of the above table. E.g. Continue to fill in details of "Serial No 1" (Above) in "Serial No 1-Continue" row below.
Serial
No

Designation

Reasons for Leaving

Reporting Manager's Name

and contact number)*

If Employment Type is Contractual, Please Provide Outsourcing Agency Name, Complete

Address and Contact Number
Organisation Name

Complete Address

Pin Code

Contact Number

Organisation Name

Complete Address

Pin Code

Contact Number

Organisation Name

Complete Address

Pin Code

Contact Number

01

02

03
*Current Reporting Manager will be contacted ONLY AFTER the candidate joins IBM
Total years of experience - (please do not include any
training or internship experience)
Page 4 of 8, Employment Application form V 02, wef - 11th May 2015

Years

Months

State GAP in
Employment if any:

009876533

OTHER DETAILS (Fill in CAPITAL Letters)

Current Annual Remuneration/ Cost to company
If you are related to IBM India Private Limited employees and/or Directors (sibling / spouse/ children/in law relationships), please provide names and relationship.
Name

Designation

Business Unit

*Have you ever been convicted? Are criminal charges pending against you?

Yes

No

Relationship

If yes state the offence

Yes

*Have you worked for the Government, whether as a civilian employee or member of the military?

No

All Candidates must indicate if they have worked for the Government, whether as a civilian employee or member of the military. If so, you must also indicate whether you had any responsibilities or were involved in
activities relating to IBM or an affiliated Company. You must also state whether you are aware of any legal restrictions on what work you may do for IBM or an affiliated Company, and if so, what those restrictions are.
Name of Government Organization and Department
Tenure
Job Responsibilities
Restrictions (if any)

DECLARATIONS
Source Declaration
1. If applicable, I hereby confirm that in my duties as a government employee, I have (or have had) no
matters involving IBM (in any capacity whatsoever), or if I do, that I have officially withdrawn from
participating in those matters while I am discussing potential employment with IBM. All details of any
such matters that I have been involved with, where IBM or any of its affiliates have been involved, are
listed above.
2. I confirm that the information provided by me in this application form is complete and accurate.
3. I understand that if any information provided by me with respect to my application for employment is
found to be untrue, inaccurate or misleading, IBM INDIA Private Limited may withdraw any offer of
employment made to me or terminate my employment (If I have already joined IBM India) without notice.
3. I understand that all the details provided in this application are subject to verification.
4. I hereby authorize IBM India Private Limited and its representatives (including reference check
agencies/third party vendors) to verify information provided in my application for employment and to
conduct enquiries as deemed necessary by the company.

By submitting the IBM Employee Referral name I confirm that the referrer is known to me personally or
professionally. This relationship may be a result on account of participation in various social networks which
are either formal (examples of formal networks are Linkedin, Facebook, Twitter, industry and competency
associations) or informal (examples of informal networks are former employment with the same company,
friends circle, alumni from same educational institution or study circles) .
I also confirm that the referrer has made me aware that by referring my candidature to IBM for an opportunity
of employment, he/she may be eligible to receive a referral bonus.

*Date
*Signature
Enter full name

Page 5 of 8, Employment Application form V 02, wef - 11th May 2015

*Place

(DD-MMMYYYY)

BACKGROUND CHECK APPLICATION FORM - I

Last Name
Date of Birth

Middle Name
Gender

Father's Name

Social Security # / National Insurance #

First Name
Nationality

Passport No:

IBM GOM Code / IBM Employee ID

Proof of name change attached if applicable

Yes

No

EDUCATION (Please mention only highest completed education as declared in Employment Application Form)
Name of Degree / Diploma

Also indicate Specialization of the Degree/

Diploma

*Name & Location of School/College/Institute

(also mention whether course attended is
Regular/correspondence)

Dates
attended

Name & Location of university to which the

college/Institute is affiliated to

From MMM / YYYY

To MMM / YYYY

From MMM / YYYY

Year of
passing

Roll Number / Registration Number / Exam Seat

Number

Note : If you are a Fresher, please specify " NA" in all the fields below.
EMPLOYMENT RECORD: Starting with your present or most recent employer, please list last 3 employments in chronological order. When listing consulting or temporary assignments under "Employer", state the name
of the consulting or temporary agency that placed you at the client site

CURRENT / MOST
RECENT EMPLOYER
(Company Name)

From

Job Title

To

Employee ID :

Complete Address

Reason for
Leaving :

Employment status (Permanent /Contractual)

OUTSOURCING AGENCY DETAILS

Pin code

Name
Full Address

-----------------PREVIOUS EMPLOYER
(PRIOR TO THE MOST
RECENT (Company Name)

From

Job Title

To

Employee ID

Complete Address

Reason for
Leaving

Employment status (Permanent /Contractual)

OUTSOURCING AGENCY DETAILS

Name
Full Address
Page 6 of 8, Employment Application form V 02, wef - 11th May 2015

Pin code

BACKGROUND CHECK APPLICATION FORM - I contd.

SECOND PREVIOUS
EMPLOYER (Company
Name)

From

Job Title

To

Employee ID

Complete Address

Reason for
Leaving

Employment status (Permanent /Contractual)

OUTSOURCING AGENCY DETAILS

Pin code

Name
Full Address

INFORMATION RELEASE AUTHORIZATION ( TO BE SIGNED BY THE CANDIDATE)

I certify that the statements made in this application are valid and complete to the best of my knowledge. I understand that false or misleading information may result in termination of employment.
If upon investigations, any of this information is found to be incomplete or inaccurate, I understand that I will be subject to dismissal at any time during my employment. I hereby authorize IBM and /or any of its
subsidaries or affiliates, and any persons or organizations acting on its behalf to verify the information presented on this application form and to procure an investigative report or consumer report for that purpose. I
hereby grant authority for the bearer of this letter to access or be provided with full details of my previous records.
In addition, please provide any other pertinent information requested by the individuals presenting this authority. I hereby release from liability all persons or I authorize to contact my present employer
I have read, understand and by my signature consent to these statements.

*Signature

Enter full name

*Date
(DD-MMM-YYYY)

Page 7 of 8, Employment Application form V 02, wef - 11th May 2015

*Place

BACKGROUND CHECK APPLICATION FORM - II

Last Name

Middle Name

First Name

Date of birth

Gender

Nationality

Father's Name

Passport Number

IBM GOM
Code / IBM
Employee ID

*Current Address

Permanent Address (Please fill only if different from the current address)

* House/Flat No.

* House/Flat No.

* Street (Cross &

Main)

* Street (Cross &

Main)
* Nearest
LandMark

* Nearest LandMark

* City

*PIN Code

* State

* City

* State

*Country

*PIN Code

*Country

Point of Reference# along with Contact details

Point of Reference# along with Contact details

Name of the contact

person

Name of the
contact person

Phone Number

Phone Number

* Present Address: Address where your are currently staying

** Permanent Address: Address where you are permanently residing, irrespective of Present address. This is typically your parents residence or an address in your home town.
# Reference: Could be your Parents, Spouse, Neighbours, Friends, Relatives, Room mate who stayed with you etc. or staying in close neighborhood.

INFORMATION RELEASE AUTHORIZATION ( TO BE SIGNED BY THE CANDIDATE)

I certify that the statements made in this application are valid and complete to the best of my knowledge. I understand that false or misleading information may result in termination of
employment. If upon investigations, any of this information is found to be incomplete or inaccurate, I understand that I will be subject to dismissal at any time during my employment. I hereby
authorize IBM and /or any of its subsidaries or affiliates, and any persons or organizations acting on its behalf to verify the information presented on this application form and to procure an
investigative report or consumer report for that purpose. I hereby grant authority for the bearer of this letter to access or be provided with full details of my previous records. In addition, please
provide any other pertinent information requested by the individuals presenting this authority. I hereby release from liability all persons or I authorize to contact my present employer.
I have read, understand and by my signature consent to these statements.

*Signature
Enter full name

Page 8 of 8, Employment Application form V 02, wef - 11th May 2015

*Date
(DD-MMM-YYYY)

*Place