Robert Bosch Engineering and Business Solutions Limited

Application for Employment

(Recent Passport Size

Position applied for Location Date (dd/mm/yyyy) Photograph To Be Affixed
                  During The Time Of
Interview)
General Instruction
Type or print this application form ; Specify all dates using DD/MM/YYYY format ; If not hand written,
sign at the bottom of each page

Personal Information
                 
First Name Middle Name Last Name
           
Date of birth (dd/mm/yyyy) Gender E-Mail ID

                             

Place of Birth: City & State Mother Tongue Nationality Religion
           
Change of Name if Applicable (Former Name / Maiden Name ) Date of Name Change

                       

Date of Issue Valid till
Passport Number Place of Issue ECNR
(dd/mm/yyyy) (dd/mm/yyyy)
Any ID issued by a competent Government or other agency? (Driving licence, passport, PAN card, Phone bill, Bank passbook others) :

If yes, Please attach photocopy of anyone document.

Current Address
Door No.       House Name      
                      Street                      
                                                 
Landmark                                            
City       State       Pin      
Residence phone with STD       Mobile Number      

Permanent Address : Same as Above

Door No.       House Name      
                      Street                      
                                                 
Landmark                                            
City       State       Pin      
Residence phone with STD       Mobile Number      
Domiciliary state       Period of stay      

Family Information
Marital Status Date of Marriage (dd/mm/yyyy) :
                       
Spouse’s Name - First Middle Last Occupation
No. of dependents (Other
Number of children
than Spouse & Children)
                       
Father’s Name - First Middle Last Occupation
                       
Mother’s Name - First Middle Last Occupation

KG Campus, No.363, Thudiyalur Road, Saravanampatti, Coimbatore – 641035, India 1

Telephone: +91 422 663 4000 Telefax : +91 422 663 4104
Registered Office : 123, Industrial Layout, Hosur Road, Koramangala, Bangalore – 560 034, India
Robert Bosch Engineering and Business Solutions Limited

Education (Begin with the highest education qualification & end with class X; Attach legible photo copies of Mark sheets / Degree
Certificate / Provisional Degree Certificate)

Year of passing
Name of Institute / (Month / Year) % of Class /
Course / Degree Location Specialization
University Marks Rank
From To

Post Graduation                                          

Graduation                                          

Diploma                                          

Pre-University /
                                         
12th Std

School / 10th Std                                          

Others                                          

                                               

Please provide additional information for Post Graduation

Post Graduation I SEM II SEM III SEM IV SEM V SEM VI SEM Aggregate

Percentage                                          

Backlogs                                          

Please provide additional information for Graduation

Graduation I SEM II SEM III SEM IV SEM V SEM VI SEM VII SEM VIII SEM Aggregate

Percentage                                                      

Backlogs                                                      

Please provide additional information for Diploma

Diploma I SEM II SEM III SEM IV SEM V SEM VI SEM Aggregate

Percentage                                          

Backlogs                                          

KG Campus, No.363, Thudiyalur Road, Saravanampatti, Coimbatore – 641035, India 2

Telephone: +91 422 663 4000 Telefax : +91 422 663 4104
Registered Office : 123, Industrial Layout, Hosur Road, Koramangala, Bangalore – 560 034, India
Robert Bosch Engineering and Business Solutions Limited

Professional Work Experience (Present / Last Employment)

Company Name       Key job responsibilities

Building No.           Street                              

                                             
Landmark                                        
City       State       Pin      

Employee ID      
Current Designation & Department            
Date of joining      
Reason for seeking change       Last drawn salary
Supervisor’s Name & Designation            
Supervisor’s Direct Number & Mail Id      
Type of employment      
Are you under any bond?
If yes, specify bond period or amount / period      
Can the employer be contacted now? If No, then provide an alternate date to contact      
Reporting structure
     

Professional Work Experience (Past Employment)

1. Name of the company       Key job responsibilities
Building No.           Street                                
                                           
Landmark                                        
City       State       Pin      
Date of joining & Leaving            
Duration of employment       Last drawn salary

Reason for seeking change            

2. Name of the company       Key job responsibilities

Building No.           Street                                
                                             
Landmark                                        
City       State       Pin      
Date of joining & Leaving            
Duration of employment       Last drawn salary
Reason for seeking change            
Please use additional sheet (annexure I) if space is not sufficient.

Technical & Domain skills (List skills which relate to the position applied for & rate them as per scale defined)
1 – Basic Awareness; 2 – End user; 3 – Require guidance; 4 – Can deliver independently; 5 – Ability to train / guide others

KG Campus, No.363, Thudiyalur Road, Saravanampatti, Coimbatore – 641035, India 3

Telephone: +91 422 663 4000 Telefax : +91 422 663 4104
Registered Office : 123, Industrial Layout, Hosur Road, Koramangala, Bangalore – 560 034, India
Robert Bosch Engineering and Business Solutions Limited
Skill Description Self Evaluation

                 

                 

                 

                 

                 

                 

Training / Development Program / Certification (Specify date in dd/mm/yyyy format)

Program Name & Location of Institution Details From To

                             

                             

                             

                             

REFERENCES
Details of persons under whom you have either worked or who know you professionally for at least 6 months
Organization & Nature of Phone No. (With STD Code)
Name Duration E-Mail ID
Designation Association Residence Office

                                         

                                         

                                         

Details of friends / relatives employed in BOSCH

Organization & Nature of Phone No. (With STD Code)
Name Duration E-Mail ID
Designation Association Residence Office

                                         

                                         

                                         

KG Campus, No.363, Thudiyalur Road, Saravanampatti, Coimbatore – 641035, India 4

Telephone: +91 422 663 4000 Telefax : +91 422 663 4104
Registered Office : 123, Industrial Layout, Hosur Road, Koramangala, Bangalore – 560 034, India
Robert Bosch Engineering and Business Solutions Limited

Additional Details

Professional Achievement
Membership of      
Professional Association
Research Papers / Articles      
published
Patents / License      
Registered

Interests
Achievements in Sports,
     
Literary activities etc.

Awards received      

Hobbies & Special

     
Interests

Health

Height (Cm) Weight (Kg) Blood Group Physical handicaps, if any, please provide details
                       

Have you suffered from any major illness / Surgery / accident in the last
five years? If yes, please provide details
     
Chronic illness if any (high blood pressure, diabetes, etc)      
Information on major surgical operations if any      
Information on most recent illness, if any      

Statutory Membership Account Number

Are you a member of Employees’ Provident Fund Scheme (EPF)?      
Are you a member of Family Pension Scheme (EPS)?      
Are you a member of Employees’ State Insurance Scheme (ESI)?      

Contact person in case of emergency (preferably local) :

Name      
Door Number                     Relationship      
House Name                                          
Street                                          
Landmark                                          
City       State       Pin      
Residence phone
      Mobile Number      
with STD

KG Campus, No.363, Thudiyalur Road, Saravanampatti, Coimbatore – 641035, India 5

Telephone: +91 422 663 4000 Telefax : +91 422 663 4104
Registered Office : 123, Industrial Layout, Hosur Road, Koramangala, Bangalore – 560 034, India
Robert Bosch Engineering and Business Solutions Limited

Language Proficiency

Language                  

Can Speak

Can Read

Can Write

Other Details

Have you been interviewed by Bosch before?

If yes, provide details (Division / Location / Month / Year)
     

Have you ever been arrested, prosecuted or convicted for any

criminal offence, other than minor traffic offences If Yes, provide details      

Social security no. / any ID no. issued by competent Government

office If Yes, specify the details      

Do you have any commitment to another employer or organization

that might affect your employment with us? If Yes, provide details      

Any other information you would like us to know which may have significant bearing on our hiring decision?
If Yes, provide details      

Certification by Candidate

I certify that the statements made by me above are true, complete and correct. I agree that in case the company finds at any time, the
information provided by me in this application form is not correct, true or complete, the company will have the right to withdraw, if
selected, the letter of appointment before I join the services or to terminate my appointment at any time without notice or compensation
after I have taken up service.

I authorize ‘Robert Bosch Engineering & Business Solutions Ltd.’ or its agency to verify my credentials. I will cooperate and facilitate
the process of verification of my credentials / antecedents.

                       

Name of the applicant Date Place Signature

KG Campus, No.363, Thudiyalur Road, Saravanampatti, Coimbatore – 641035, India 6

Telephone: +91 422 663 4000 Telefax : +91 422 663 4104
Registered Office : 123, Industrial Layout, Hosur Road, Koramangala, Bangalore – 560 034, India
Robert Bosch Engineering and Business Solutions Limited
Remuneration Details : Annexure II

KG Campus, No.363, Thudiyalur Road, Saravanampatti, Coimbatore – 641035, India 7

Telephone: +91 422 663 4000 Telefax : +91 422 663 4104
Registered Office : 123, Industrial Layout, Hosur Road, Koramangala, Bangalore – 560 034, India
Robert Bosch Engineering and Business Solutions Limited

Name:      
Please furnish your present remuneration details. Date of last salary revision:      
Date of next salary revision:      
Compensation Element Amount (Rs.) Remarks

1. Cash components per month:      

Basic Salary      

Dearness Allowance      

House Rent Allowance      

Conveyance Allowance      

Children’s Education Allowance      

Special Allowance      

Other Perquisites      

Gross Salary per month      

2. Retirals:      

PF      

Gratuity      

Superannuation      

Total Per month      

3. Cash components per annum:      

Incentives      

Bonus      

LTA      

Other Perquisites      

Total      

CTC ((1+2) X 12 +3 )      

Deductions / Recoveries, if any      

CTC Per Annum      

Expected CTC Per Annum      

I certify that the particulars furnished by me are correct.

     
Date :       Signature

Note: Please attach a copy of last drawn salary slip / other endorsement in support of the above particulars.

Professional Work Experience (Annexure I)

3. Name of the company       Key job responsibilities

KG Campus, No.363, Thudiyalur Road, Saravanampatti, Coimbatore – 641035, India 8

Telephone: +91 422 663 4000 Telefax : +91 422 663 4104
Registered Office : 123, Industrial Layout, Hosur Road, Koramangala, Bangalore – 560 034, India
Robert Bosch Engineering and Business Solutions Limited
Building No.           Street                                
                                             
Landmark                                        
City       State       Pin      
Date of joining & Leaving            
Duration of employment       Last drawn salary
Reason for seeking change            

4. Name of the company       Key job responsibilities

Building No.           Street                                
                                             
Landmark                                        
City       State       Pin      
Date of joining & Leaving            
Duration of employment       Last drawn salary
Reason for seeking change            

5. Name of the company       Key job responsibilities

Building No.           Street                                
                                             
Landmark                                        
City       State       Pin      
Date of joining & Leaving            
Duration of employment       Last drawn salary
Reason for seeking change            

6. Name of the company       Key job responsibilities

Building No.           Street                                
                                             
Landmark                                        
City       State       Pin      
Date of joining & Leaving            
Duration of employment       Last drawn salary
Reason for seeking change            

Name:      

     
Date:       Signature

KG Campus, No.363, Thudiyalur Road, Saravanampatti, Coimbatore – 641035, India 9

Telephone: +91 422 663 4000 Telefax : +91 422 663 4104
Registered Office : 123, Industrial Layout, Hosur Road, Koramangala, Bangalore – 560 034, India