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GUJARATSTATE FERTILIZERS
& CHEMICALSLIMITED
An ISO Certified Company Promoted by Gow. of Gujarat
P.O.Fertilizernagar,
391 750, Dist. Vadodara,Gujarat
EMPLOYMENT
APPLICATIONS
FORM
Affix Pass-PortSize
Pl. note that incomplete form will not be considered. fFo be filled in Block letters) colour Photograph

Contact Details
FULLNAMEDR/ MR/ MRS/ MISS(in Blockletters)
SURNAME FIRST MIDDLE

PresentAddress: PermanentAddress:

P i nc o d e : - Phone: Pincode: Phone:

-
ContactNo. MobileNo. Email:
PrimaryInformation
Main Qualification_
EDUCATTONALQUALTFICAT|ONS
(Startingwith recentmost)(useseparatesheet if required)

Examination Board/ Year of Class/ % Marks Principal

Institution University Passing Division Obtained Subject

ComputerSkills:

EMPLOYMENT (in descendingorderXuseseparatesheet if required)

HISTORY

Duration
5r. Name and Addressof Position/s Nature Salary
No. Company/ Organization held of drawn
From date To date work (crc)
DD/MM/YY DD/MM/YY
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(useseparatesheet if required )
TRAININGUNDERGONE

Name of Organization/ Duration Brief Description Stipendor

lnstitution of Training Honoraium
Fromdate To date
DD/MM/YY DDIMM/YY

Other Information
Hometown: Domicile: Rlystation:
Placeof Birth : Village Dist.: State:
Date of Birth : I Age: Nationality: Reli gi on:
B l o o dG r o u p : MaritalStatus:

Name& Occupation
of Husband/ Wife / Father/ Guardian

Languages
known Read Write Speak
a)
b) MotherTongue
c)
d)

Do you belongto Schedule

Caste/ Tribe? Yes/ No
Do you belongto BackwardClass? Are you a LandLoser?
Yes/ No
Yes/ No
Are you an Ex-Serviceman
? Yes/ No lf yes,5urveyNo.
Whetherphysicallychallenged? Yes/ No
Village
(lf yes,Pleaseattachcopyof certificate/proof)
Are you relatedto any of lf yes,Nameof Director Relationship
our presentDirectors?
Yes No

Haveyou any relativeworking in GSFC

LTD.? Yes No
lf yes,Name& Relationship
Are you EmployeeDependent/ Ex-Employee Dependent/ Deceased
EmployeeDependent?
lf yes,givefollowingdetails:
Name& ECNo. Relation Designation Department
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Haveyou ever been dismissed/ discharged/ terminated for any act of misconductin any of your previous
employmentor convictedfor any criminal of other offences? Yes/ No, if yes, give precise
detailson a separatepaper.

Extracurricularactivities(Proficiency (if any),Hobbies,etc.)(useseperatesheet,if required)

in Sports/Games

Scholastic / Prizes,etc. if received(useseperatesheet,if required).

Honours/ Scholarships

How soon can you join, if Selected?

Minimum Total emolumentsacceptable, Rs./Annum.

: (Not relatedto applicant& must be residingin India.)

References

5r. P h o n e/ E - m a i/l
Name Occupation Address
No. M o b i l eN o .

Any other relevant information, in support of your application, e.g. Membership of professional
organizationresearchpapers,articlesand any other publicationand merit awardsetc. (useseparatesheet,if
required).

DECLARATION

Should any information stated by me in this applicationbe found incorrect,employmentwith Companyis

liablefor immediateterminationwithout paymentor any compensation thereof.

I declarethat I had no previousconviction.

Date Place: 5ignature

C h e c k eBd y : N a m e :

S i g n a t u r e: