Ref. No:

Akurdi, Pune – 411 035. INDIA

Please fill in this form carefully and completely in your own hand-writing.

(position applied for)

Name in full :

(Block letters please)

Name in brief ( e.g. : B.D.Deshmukh )

Date of Birth : Age : Yrs Height : Weight :

ADDRESS

Present: Permanent:

Phone: Office: Phone:

Residence:

E- mail -

FAMILY BACKGROUND :

Marital status : No. of Children : Ages :

Father / Mother (Age,Occupation):

Brothers / Sisters ( Age,Occupation):

ACADEMIC RECORD

Period Course

Post-Graduate / Professional Record / Training / Seminars :

Year PassedDuration of

CoursrQualifications

PTO

Photograph

School/College & University Main Subjects Class

Institute / University Passed at which attempt % of marks & distinction if any

(1)

Confidential

From To

(2) PTO

Year & Month

DETAILS OF PAST EXPERIENCE STARTING WITH PRESENT EMPLOYMENT WORKING BACKWARDS

No. of

YearsName and Address of Employer Nature of employer's business Designation

Brief description of appointment and

responsibility

Akurdi, Pune – 411 035. INDIA

Name: Post Applied:

Whether Payslip is enclosed : (Yes / No)

(A) DESCRIPTION PER MONTH PER ANNUM

1 Basic Salary

2 Fixed Dearness Allowances

3 Variable D.A

4 House Rent Allowances

5 Education Allowances

6 City Compensatory Allowances

7 Production Incentive

8 Washing Allowances

9 Conveyance Allowances

10 Others:

Total Monthly:

(B) REIMBURSEMENTS EQUATED TO MONTHLY

1 Leave Travel Allowance

2 Medical - Domiciliary

- Hospitalisation

3 Reimbursement of Conveyance Exp.

4 Any Other Reimbursements

5 Furniture Scheme / Soft Furnishing

6 Bonus / Exgratia

Total Reimbursement:

( C ) RETIREMENT BENEFITS : P.F % F.P.S. %

Gratuity % Superannuation %

(D) OTHER PERKS / FACILITIES

1 Co. Car :

2 Telephone :

3 Club Membership :

4 Furniture Scheme :

(E) WHAT REMUNERATION YOU EXPECT :

SALARY DETAILS

'(1) PTO

Present Appointment :

Position held :

PTO

Name and Address

of employer :

Nature of employer's

business :

Approximate No. of

employees :

Special Achievement / Contribution if any :

Approximate Annual

turnover :

Date of Joining :

(3)

Date of appointment to

present position

DRAW AN ORGANISATION CHART SHOWING YOUR POSITION

Please outline your present job responsibilities :

:

:

:

( 1 )

( 2 )

( 3 )

( 4 )

Present State of health

Names and addresses of References :Please indicate whether we may

contact them straightway.

Have you been earlier interviewed by us - (If yes, Please give details)

If you have held your present appointment for less than one year, please describe your previous

appointment detail as possible in an attached sheet.

Please set your any information which you think should be taken into account in considering your

application

Reason for seeking new

job

Language known

Signature

How soon would you be free to take up a

new appointment ?

Date :

May we refer to your previous employers ?

(No reference will be made to the present

employer without your permission )