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

FILL ALL DETAILS IN CAPITAL LETTERS Please affix your passport size photo here

*Title Ms.

* 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

VINOTHINI

*Last Name / Family Name Father's Name

K KUMAR V

*Date of Birth *Mobile Number

DD MMM YYYY Country Code Mobile Number

20 Aug 1993 91 9597990320

*Personal
Telephone (Landline)
Email ID
Country Code City Code Phone Number
kvinothini.ece@gmail.com
91 0435 2410024
PAN Card Passport Number

AVFPV8125R
Place of Issue of Passport Expiry Date
DD MMM YYYY

*Nationality Country Of Birth City Of Birth

INDIAN INDIA PONDICHERRY

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

Agency Enter Agency name

Employee Name of the Employee Referrer's employee

Referral (Referrer Name) Number

Referrer's E- Mail ID

Enter the jobsite name Social Networks (Website

Job Site Name -Facebook/ LinkedIn/
here
Twitter/ Google+)

X Direct

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

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) M.E ** 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

Name of the
Complete Name & Address of School / College / Institution and Registration / Degree
Percentage/
Qualification Course Tenure Name of the University Roll / Final Year Awarded
Grade Points
*University name is mandatory where applicable(DO NOT ABBREVIATE) Seat Number (e.g.. B.com /
BA/ Mtech)

St. JOSEPH'S GIRLS HIGHER SECONDARY SCHOOL, KUMBAKONAM

MMM YYYY
School/
College/
Jun 2007 Institution
Start Date
details (Name
& Address
May 2008
End Date
SSLC (10th) 94.80% 536677 SSLC
May 2008
Year Of Passing
University
Details (Name
& Address) if
applicable

St. JOSEPH'S GIRLS HIGHER SECONDARY SCHOOL, KUMBAKONAM

MMM YYYY
School/
College/
Jun 2009 Institution
Start Date
details (Name
& Address
May 2010
End Date
HSLC (12th) 92.90% 786329 HSC
May 2010
Year Of Passing
University
Details (Name
& Address) if
applicable

ANJALAI AMMAL MAHALINGAM ENGINEERING COLLEGE, THIRUVARUR

MMM YYYY
School/
College/
Aug 2010 Institution
Start Date
details (Name
& Address
May 2014
End Date
Graduation ANNA UNIVERSITY - CHENNAI 8.69 80310133096 B.E
May 2014
Year Of Passing
University
Details (Name
& Address) if
applicable

COLLEGE OF ENGINEERING, GUINDY. CHENNAI

MMM YYYY
School/
College/
Sep 2014 Institution
Start Date
details (Name
& Address
Jun 2016
End Date
Post Graduation 8.625 2014212024 M.E
ANNA UNIVERSITY - CHENNAI
Jun 2016
Year Of Passing University
Details (Name
& Address) if
applicable

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

EDUCATION DETAILS - contd. (Fill in CAPITAL Letters)

Name of the
Complete Name & Address of School / College / Institution and Registration / Degree
Percentage/
Qualification Course Tenure Name of the University Roll / Final Year Awarded
Grade Points
*University name is mandatory where applicable(DO NOT ABBREVIATE) Seat Number (e.g.. B.com /
BA/ Mtech)

M M M Y Y Y Y
School/
College/
Institution
Start Date details (Name
& Address
Others - PhD, End Date
Additional
Degrees
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? Yes X No If "YES", please provide following details:

DATE OF
LAST WORKING DAY TYPE OF EMPLOYMENT EMPLOYEE NUMBER/
BUSINESS UNIT LOCATION JOINING MANAGER'S NAME
(DD-MMM-YYYY) (Regular/FTH/Contractor) CONTRACTOR CODE
(DD-MMM-YYYY)

*Are you willing to relocate as part of If yes, please indicate

your employment with IBM? X Yes No CHENNAI BANGALORE
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 X 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
Yes X No
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

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.

Employment Type
Serial Full Time / Part
Organisation Name and address (Permanent Tenure Employee Number
No Time
/Contractual)
Organisation Name *Most Recent Start Date

Address along with PIN Code End Date

01

Organisation Name Start Date

Address along with PIN Code End Date

02

Organisation Name Start Date

Address along with PIN Code End Date

03

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 Reporting Manager's Name If Employment Type is Contractual, Please Provide Outsourcing Agency Name, Complete
Designation Reasons for Leaving
No and contact number)* Address and Contact Number

Organisation Name Complete Address

01
Pin Code Contact Number

Organisation Name Complete Address

02
Pin Code Contact Number 009876533

Organisation Name Complete Address

03
Pin Code Contact Number

*Current Reporting Manager will be contacted ONLY AFTER the candidate joins IBM
Total years of experience - (please do not include any State GAP in NA
0 0 Years 0 0 Months
training or internship experience) Employment if any:

Page 4 of 8, Employment Application form V 02, wef - 11th May 2015

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 Relationship

*Have you ever been convicted? Are criminal charges pending against you? Yes X No If yes state the offence

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

By submitting the IBM Employee Referral name I confirm that the referrer is known to me personally or
1. If applicable, I hereby confirm that in my duties as a government employee, I have (or have had) no professionally. This relationship may be a result on account of participation in various social networks which
matters involving IBM (in any capacity whatsoever), or if I do, that I have officially withdrawn from are either formal (examples of formal networks are Linkedin, Facebook, Twitter, industry and competency
participating in those matters while I am discussing potential employment with IBM. All details of any such associations) or informal (examples of informal networks are former employment with the same company,
matters that I have been involved with, where IBM or any of its affiliates have been involved, are listed friends circle, alumni from same educational institution or study circles) .
above.
2. I confirm that the information provided by me in this application form is complete and accurate. I also confirm that the referrer has made me aware that by referring my candidature to IBM for an opportunity of
3. I understand that if any information provided by me with respect to my application for employment is employment, he/she may be eligible to receive a referral bonus.
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.

*Date
*Signature (DD-MMM-
Enter full name K VINOTHINI *Place CHENNAI YYYY) 11-Oct-2015

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

 BACKGROUND CHECK APPLICATION FORM - I

Last Name K Middle Name First Name VINOTHINI

Date of Birth 8/20/1993 Gender Female Nationality Indian Passport No:

Father's Name KUMAR V IBM GOM Code / IBM Employee ID

Social Security # / National Insurance # Proof of name change attached if applicable Yes No

EDUCATION (Please mention only highest completed education as declared in Employment Application Form)
Also indicate Specialization of the Degree/
Name of Degree / Diploma M.E Diploma
EMBEDDED SYSTEM TECHNOLOGIES

*Name & Location of School/College/Institute COLLEGE OF ENGINEERING, GUINDY. From MMM / YYYY To MMM / YYYY
(also mention whether course attended is
Dates
Regular/correspondence) Sep 2014 Jun 2016
attended
Name & Location of university to which the ANNA UNIVERSITY - CHENNAI From MMM / YYYY
college/Institute is affiliated to
Year of
passing Jun 2016

Roll Number / Registration Number / Exam Seat

Number
2014212024

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

NA From NA Job Title NA

CURRENT / MOST
RECENT EMPLOYER
(Company Name) To NA Employee ID : NA

Complete Address NA Reason for NA Employment status (Permanent /Contractual)

Leaving :
NA

OUTSOURCING AGENCY DETAILS

Name NA Pin code NA

Full Address NA

------------------
PREVIOUS EMPLOYER NA From NA Job Title NA
(PRIOR TO THE MOST
RECENT (Company Name)
To NA Employee ID NA

Complete Address NA Reason for NA Employment status (Permanent /Contractual)

Leaving
NA

OUTSOURCING AGENCY DETAILS

Name NA Pin code NA

Full Address NA

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

 BACKGROUND CHECK APPLICATION FORM - I contd.

NA From NA Job Title NA

SECOND PREVIOUS
EMPLOYER (Company
Name) To NA Employee ID NA

Complete Address NA Reason for NA Employment status (Permanent /Contractual)

Leaving
NA

OUTSOURCING AGENCY DETAILS

Name NA Pin code NA

Full Address NA

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 K VINOTHINI *Date

Enter full name (DD-MMM-YYYY) 11-Oct-2015 *Place CHENNAI
Page 7 of 8, Employment Application form V 02, wef - 11th May 2015
 BACKGROUND CHECK APPLICATION FORM - II

Last Name K Middle Name First Name VINOTHINI

Date of birth 8/20/1993 Gender FEMALE Nationality INDIAN

Father's Name KUMAR V Passport Number IBM GOM

Code / IBM
Employee ID

*Current Address Permanent Address (Please fill only if different from the current address)
40/1 PL. NO.67
* House/Flat No. * House/Flat No.

BAJANAI KOIL STREET, PALLIPAT. T.T.T.I POST. ANNAI ANJUGAM NAGAR EXTN., CHETTIMANDAPAM.
* Street (Cross & * Street (Cross &
Main) Main)

THARAMANI KUMBAKONAM
* Nearest
* Nearest LandMark
LandMark

* City CHENNAI * State TAMILNADU * City KUMBAKONAM * State TAMILNADU

*PIN Code 600113 *Country INDIA *PIN Code 612001 *Country INDIA

Point of Reference# along with Contact details Point of Reference# along with Contact details
Name of the contact Name of the
person V KUMAR contact person K SHANTHI

Phone Number Phone Number

9445853794 9442580024

* Present Address: Address where your are currently staying

** Permanent Address: Address where you are permanently residing, irrespective of Present address. This is typically your parent’s 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 K VINOTHINI *Date 11-Oct-2015 CHENNAI
(DD-MMM-YYYY) *Place

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