Microgen Hygiene Pvt

Ltd.

313 – Midas, 3rd Floor, Sahar Plaza, JB Nagar, M.V. Road,

Nr. Kohinoor Hotel, Andheri (E), Mumbai 400059,
Tel: +91 22 28251870
Fax: +91 22 2832 0335

WELCOME TO THE MICROGEN FAMILY!

PERSONAL INFORMATION FORM

Please read the form carefully and then fill in the particulars in BLOCK letters in
your own handwriting. The information you submit will be treated by the company
as strictly confidential.

Page 1 MHPL/HR/CONFIDENTIAL
1. Personal Details
a)Name (in block letters)

First Name Middle Name Last Name

b)Sex Male / Female
c)Date of Birth (dd/mm/yy) Age
____Yrs._____Months

Present Address Permanent Address

(with PIN Code) (with PIN Code)

Paste Your
Photograph
here

d) Residence Mobile No. Email id.

Telephone No.

e) Contact No. in case Person to be Relation

of any emergency contacted

f) Place of Birth Nationality Blood Income Tax (PAN No.)

Group

g) Height Weight Eyesight Hearing Disability/Handicap

(if any)

cms kgs (Aided/Unaided) (Aided/Unaide

d)

2. Information about Language: (PLEASE TICK)

Languages known Speak Read Write

Page 2 MHPL/HR/CONFIDENTIAL
 3. Existing Axis Bank Account Details:
Do you have Savings account with any Bank, please give details:
Account No.: Name:
Branch:

After joining, all the payment shall be credited with Axis Bank salary account. If any delay in getting salary account number, H.O will not be
responsible for any delay/pending in payment. Therefore full responsibility of getting salary account from Axis Bank is laid with the concerned
employee only.

4. EDUCATION & TRAINING DETAILS

Subject of
Degree /Diploma University /Institute Year of Passing Grade
Specialization

a) TECHNICAL / COMPUTER QUALIFICATIONS

Subject of
Degree /Diploma University /Institute Year of Passing Grade
Specialization

b) TRAININGS/SEMINARS ATTENDED

5. EXTRA CURRICULAR ACTIVITIES/HOBBIES

6. MEMBERSHIP WITH CLUBS / ASSOCIATIONS 7.

Other
Details

Page 3 MHPL/HR/CONFIDENTIAL
 Have you resided abroad?
Live with parents
Where? When (Period)?
Rented House

Live with Relatives Own House Passport No.:-

8. FAMILY DETAILS:
Marital Status Marriage Date Spouse’s Date of Birth

Father’s Name Father’s Occupation

Spouse’s Name Spouse’s Occupation

No. of Sisters __________ No. of Brothers ____________ Children ________________

Name of Child Sex Date Of Birth

9. DETAILS ABOUT OWN VEHICLE

Do you own a vehicle (Y / N)? If (Y), please specify (two / four-
wheeler)

10. EMPLOYMENT DETAILS:

Start with first employment, mention period of unemployment separately, promotion in the
same company is to be treated as a separate item.
Total Cost to
Position
Date of Joining Date of Leaving Company (p.a.) Reasons for
Employer’s Name (dd/mm/yy) (dd/mm/yy) held Start Last leaving

Page 4 MHPL/HR/CONFIDENTIAL
 Expected Salary: ______________(Annual CTC)

Notice Period _________________

11.You may give any other information about yourself, your skill set that you
may like us
to note

13. ORGANIZATIONAL CHART

Organizational Chart
(Of your current reporting
Hierarchy)

14. REFERENCES:
Are you related to or known to any present or previous employee of this company?
If so, details below –

Name Department Designation Relationship

Page 5 MHPL/HR/CONFIDENTIAL
 a) Other references (not relatives)
Name Occupation Address, phone no., email
1.

2.

I , ______________________________________hereby certify that all information given is true and

and correct in my best of knowledge and belief. I understand that, any kind of wrong
information given by me will make me liable to immediate dismissal. I agree to abide
by the rules and regulations of the company.

Date : ______________ _________________

Signature

===================================================================
Office use only
Current CTC: ____________ (Per Annum)
Expected CTC: ____________ (Per Annum )

Page 6 MHPL/HR/CONFIDENTIAL