Professional Documents
Culture Documents
Annexure A Confidential
FULL NAME: DATE OF BIRTH (dd/mm/yy): / / MARITAL STATUS: Single Married CATEGORY (Non Mandatory declaration): CURRENT ADDRESS: PLACE OF BIRTH: FATHERS / HUSBANDS NAME: General / SC / ST / OBC PERMANENT ADDRESS:
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ACADEMIC & PROFESSIONAL QUALIFICATIONS (Starting with Graduation): Name of College / Institution Affiliated University: Address: Period From (mm/yyyy): _______________ To (mm/yyyy): _______________ Marks/Percentage/CPA Obtained: Name of College / Institution Affiliated University: Address: Period From (mm/yyyy): _______________ To (mm/yyyy): _______________ Marks/Percentage/CPA Obtained: Full Time Part Time Correspondence Result Awaited Full Time Part Time Correspondence Result Awaited Course Pursued: Course Pursued:
Confidential
EXPERIENCE: (Last 3 employments in reverse chronological order starting with current employment) Company (1) Name: Company Address & Telephone Nos: Full Time Part Time Contractual Nature of Responsibilities (In brief): Reasons for leaving: REPORTED TO: Name: Designation: Contact No: Email: Reporting Period: (In case reporting period to above supervisor is less than 9 months, kindly give details of person you reported to earlier). Company (2) Name: Company Address & Telephone Nos: REPORTED TO: Name: Designation: Contact No: Email: Reporting Period: Period From: (dd/mm/yyyy): / / To: (dd/mm/yyyy): / / Position Held: Compensation Package: Employee ID: If Contractual, name and address of the agency through which appointed for the position:
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Employee ID: Confidential
Company (3) Name: Company Address & Telephone Nos: Full Time Part Time Contractual Nature of Responsibilities (In brief): Reasons for leaving: REPORTED TO: Name: Designation: Contact No: Email: Reporting Period: (In case reporting period to above supervisor is less than 9 months, kindly give details of person you reported to earlier).
Period From: (dd/mm/yyyy): / / To: (dd/mm/yyyy): / / Position Held: Compensation Package: Employee ID: If Contractual, name and address of the agency through which appointed for the position:
Confidential
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Have you ever been involved in any criminal court case? Yes / No (If yes, please give details).
______________________________________________________________________ ______________________________________________________________________ References Give two references not related to you (at least one from your previous employer)
Sl No. Name Designation Address, Telephone Number & Email Id
AUTHORISATION TO CONDUCT PRE-EMPLOYMENT SCREENINING All the information furnished by me in the Candidate Information Sheet is true to the best of my knowledge. I hereby authorize the company or any third party retained by them to make inquires, either by written communication, by telephone, online, or in person to any former employer, government agency, educational institution, state police, military establishment or any other persons or institutions knowledgeable of my background as to my prior history, work experience, nature of duties, CTC, performance levels, reliability, responsibility, honesty and any other measures of my character or personality. A Photostat, or any other copy, of this instrument bearing my signature or forwarded from my email address, shall be equally legally valid as the original. SIGN: _____________________ NAME: _____________________ DATE: _____________________
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PLACE:_____________________