APPLICATION FORM

Please fill in the details with utmost attention, as these shall be verified by British Council and/ or
by its Authorized representatives. Please Affix Your
Passport Size
All details are compulsory. Photograph

PERSONAL DETAILS
Name of Applicant: Surname Middle First

Date of Birth (DD/MM/YY) Place of Birth:

Sex: Nationality:

Father’s Name: Passport No.:

Home Phone: Office Phone: Mobile:

RESIDENTIAL ADDRESSES

PERMANENT ADDRESS:

City: State:

Pin: Phone No.:

Duration of Stay: From (mm/yy) To (mm/yy)
Nature of location: Rented Own Other (Specify)

CURRENT ADDRESS:

City: State:

Pin: Phone No.:

Duration of Stay: From (mm/yy) To (mm/yy)
Nature of location: Rented Own Other (Specify)

All fields are mandatory Strictly Private & Confidential

 References: All candidates must provide details of three referees including their current or
most recent employer, or most recent academic referee.

Particulars Reference 1 Reference 2 Reference 3

JAZEEL ANAZ KIRAN

Name

FRIEND COLLEAGUE FRIEND

Relationship /
Association Type

PRIVATE BUSINESS DENTIST MERCHANT NAVY

Organization
(Name of the
Company / College
with Address)

MANAGER DOCTOR OFFICER

Designation / Position

Landline No.

7012302342 8848417585 7507889608

Mobile No.

Jazahammed94@gmai anazkalliyath@gmail.co Kirankiran99588@gmail.c

l.com m om
Email Address

All fields are mandatory Strictly Private & Confidential

Educational record details need not be filled
EDUCATION DETAILS
DATES
ATTENDED ROLL
NAME & NAME & ADDRESS OF
COURSE MARKS (%) NUMBER/
ADDRESS OF BOARD / UNIVERSITY YEAR
QUALIFICATION ATTENDED CGPA REGISTRATION
SCHOOL / TO WHICH THE SCHOOL / OF YEAR
TYPE (MORNING/ EVENING/ & NUMBER/
COLLEGE/ COLLEGE / INSTITUTE CORRESPONDENCE) ENROL PASSED
CLASS EXAM SEAT
INSTITUTE IS AFFILIATED TO MENT (MM/YY) NUMBER
(MM/YY)

SSC
(X TH GRADE)

HSC
(XII TH GRADE)

GRADUATION

DEGREE:

DISCIPLINE:

POST
GRADUATION

DEGREE:

DISCIPLINE:

ANY OTHER

REASONS FOR BREAKS IN EDUCATION: ______________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

All fields are mandatory Strictly Private & Confidential

Employment record details need not be filled
EMPLOYMENT RECORD: Starting with your present or most recent employer, please list last 5 employments. When listing consulting or
temporary assignments, under “Employer”, state the name of the consulting or temporary agency that placed you at the client site. Complete and
accurate dates (month/year) must be provided.
PREVIOUS EMPLOYER 1/PRESENT Employee Id: From (mm/yy): To (mm/yy):
EMPLOYER:
Street Address: Employer’s Fax No.:
Phone No.:
City: State: Country: Postal Code:

Job Title: Reason for Leaving:

Employment Status: (Please check the relevant box) Supervisor’s Details:
Name:
Full Time
Contract /Through Outsourcing Agency Title:
Phone No.:
Outsourcing Agency Details: E-mail id:
Name: (Preferably official)
Address: HR Manager’s Details:
Tel No.: Name:
Description of Duties: Phone No.:
E-mail id:
(Preferably official)

EMPLOYMENT RECORD CONTINUED:

PREVIOUS EMPLOYER 2: Employee Id: From (mm/yy): To (mm/yy):
Street Address: Employer’s Fax No.:
Phone No.:
City: State: Country: Postal Code:
Job Title: Reason for Leaving:
Employment Status: (Please check the relevant box) Supervisor’s Details:
Name:
Full Time Title:
Contract /Through Outsourcing Agency Phone No.:
E-mail id:
Outsourcing Agency Details:
(Preferably official)
Name:
Address: HR Manager’s Details:
Name:
Tel No.:
Description of Duties: Phone No.:
E-mail id:
(Preferably official)

REASONS FOR BREAKS IN EMPLOYMENT HISTORY: ______________________________________________

____________________________________________________________________________________________

All fields are mandatory Strictly Private & Confidential

 INFORMATION RELEASE AUTHORIZATION

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 disqualify me from employment and /or result in termination of employment.

I understand that British Council may request a verification of information provided by me and /or background check from an agency hired
by British Council for this purpose.

I further understand that the results of verification and checks and any records made out of that information will be used for employment
purposes only and will not be given to unauthorized persons.

I authorize British Council and/or its agents Pinkerton India Pvt. Ltd. to conduct a verification and background check including but not
limited to the verification and check of information and references stated by me in this application for the consideration of British Council
to be used only for my employment purposes.

I also authorize all the concerned persons, authorities, organizations, their employees, agents or authorized representatives, whether named
in the application or not, to release the information in their knowledge / possession / records relevant to my employment.

In the event that British Council and /or its agents are unable to verify any information and references stated in this application, it is my
responsibility to furnish the necessary documentation in support of that information.

I fully understand that this application or subsequent employment does not create a contract of employment nor guarantee employment for
any definite period of time and my employment decision will always be at the sole discretion of British Council

I have read, understood, and by my signature consent to these statements.

I authorize British Council to contact my present employer if needed. Yes No

If No, let us know when we can contact your present employer: Date (dd/mm/yyyy)
SIGNATURE:

DATE:
NAME (IN BLOCK LETTERS):

DOCUMENTS REQUIRED (COMPULSORY)

Completed & Signed Application Form
Copy of Relevant Education Certificates
Copy of all past Employment Relieving Letters / Salary
Slips
Two Passport Size Photographs
Permanent Address Proof (for criminal check).
Please note: Your name should be mentioned on the address proof.
Accepted address proofs: MTNL Bill / Electricity Bill/ Copy of Rent
Agreement/ Passport/ Voter Id/ Driving License.

All fields are mandatory Strictly Private & Confidential