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Application Form

Filling Instructions:
 Please provide complete Information (All Field are mandatory)
 Please do not use short forms/Abbreviations.
 Please fill up this form in uppercase letters.
 Please submit Hardcopy/Softcopy of this form along-with all your Supporting Documents
(Duly signed with a Photograph).

Candidate’s Personal Details:

Employee ID / Code:
Date of Joining :
Candidate’s Full Name First Middle Last

Father’s Name First Middle Last

Former Name(s) / First Middle Last


Maiden Name (If
applicable)
Residential Addresses status current Current Address:
/Permanent address.

*** (Note: If both the addresses i.e. Current and


Previous are same, mention a remark i.e. Both
addresses are same)
 Please provide a copy of your ID Duration of stay at this address: From - To
Proof /Address Proof.
Permanent Address:

Duration of stay at this address: From - To


Gender:
Date of Birth: (DD/MMM/YYYY)
 Female  Male
Mobile number:
Alternate / Emergency contact number:

1
Education Details - Highest
Highest Qualification
Specialization

Course Start Date

Course End Date

Percentage / Grades / Marks obtained

Seat Number

Registration Number
Course Type  Full Time
 Part Time
 Distance
 Others, please specify
Complete name and address of the
College/ Institute from where
qualification attained
Complete name and address of the
University from where qualification
attained
Documents attached

Any other information you would like to share / provide:

2
Employment Details (Previous Employer- 1)
Company Name :

Company Address (Main Office and Branch where worked):

Main Office address:


Company Board Line Numbers:
Branch Address where worked:

Employee Code
Designation and Department
Date of Joining
Date of Leaving
Salary Details (specify per annum / per month)
Reporting Manager’s Name and Designation /
Mobile no
Name of HR /Email ID /Phone number
If Deputed by Agency - Agency name and address
Tel. No. of the Agency

Employment Type  Permanent


 Temporary
 Contractual
 Others, please specify
Documents attached : Please mark Experience /Service certificates/Reliving Letter/Last Salary Slip.

Any other information you would like to share / provide:

Attention:

 Please provide the Employee Code mandatorily and clearly.


 Please provide a copy of the last Salary Slip of the employment mentioned above.
 Please provide a copy of your Relieving Letter and Service Certificate for the employment mentioned above.

3
Employment Details (Previous Employer- 2)
Company Name :

Company Address (Main Office and Branch where worked):

Main Office address:


Company Board Line Numbers:
Branch Address where worked:

Employee Code
Designation and Department
Date of Joining
Date of Leaving
Salary Details (specify per annum / per month)
Reporting Manager’s Name and Designation
/phone number
Name of HR /Email ID /Phone number
If Deputed by Agency - Agency name and address
Tel. No. of the Agency

Employment Type  Permanent


 Temporary
 Contractual
 Others, please specify
Documents attached : Please mark Experience /Service certificates/Reliving Letter/Last Salary Slip.

Any other information you would like to share / provide:

4
Letter of Authorization by Candidate

To whom it may concern

I understand that company may use an outside agency to verify and validate the
information I have provided including my employment, my personal background,
professional standing, work history and qualifications.

I understand that an outside background agency may obtain information it deems


appropriate from various sources including, but not limited to, the following: current and
past employers, criminal conviction records, school records, College records and
professional and personal references.

I authorize, without reservation, any individual, corporation or other private or public entity
to furnish company and the outside background agency all information about me.

I unconditionally release and hold harmless any individual, corporation, or private or


public entity from any and all causes of action that might arise from furnishing company
and the outside agency information that they may request pursuant to this release.

This authorization and release, in original, faxed or photocopied form, shall be valid for
this and any future reports and updates that may be requested.

Name in Block Capitals: _______________________

Signature of Candidate: ________________________

Date: