APPLICATION BLANK (All Information Provided Will Be Kept Strictly Confidential) It would be in the best interest, after all concerned, especially for the candidates, that this APPLICATION BLANK is duly filled with utmost honesty and thoughtfulness as the Company, as a matter of policy, does cross check the authenticity of the information provided, especially with respect to details and remuneration of previous and past employment.
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Position Applied For A) PERSONAL DATA Name in Full Present Address Phone A1
Permanent Address Phone Date of Birth
Age (in years)
Place of Birth
Marital Status
Religion
Nationality
Height (in Cms.)
Weight (in Kgs.)
Identification Marks
a.
(if any)
b. Health Details
Are you suffering from (Please tick) A2
Yes
No
Vision (if using glasses, specify No.):
Hypertension
Blood Group :
Asthma
Any serious ailment or physical disabilities :
Bronchitis Diabetes Heart Disease Are you ready to undergo a complete medical Examination by the Company Doctor? : Relation
Family Background If employed, Designation and name of the company
Name
Age
Father
Whether dependent on you
Mother A3
Wife / Husband Brothers Sisters Sons Daughters Driving License ( tick mark)
Yes
Languages Known (Underline Mother tongue. Give extent of fluency)
No
Language A4
Two Wheeler Car
A5
Speak
Read
Write
B) EDUCATIONAL DATA LEVEL
Name of Institution
English Medium (Y/N)
Passed Out (Year)
CLASS OBTAINED
MAIN SUBJECTS
BOARD / UNIVERSITY
School
Graduation B1 Post Graduation Specialization
Any Others
B2
Are you Computer Literate?
Yes / No
If yes, please tick what all of the following did you learn and the level of your proficiency in each. #
Program
1.
DOS
2.
MS Office
3.
Corel Draw
4.
Page Maker
5.
Power Point
6.
Auto Cad
Specifications (if any)
No Practical Experience
Little Experience
7. 8. 9. 10.
B3 1.
2.
3.
4.
Briefly state your outstanding achievements while studying.
Adequate Experience, Speed & Skill
Very Good Experience, Speed & Skill
C) PAST EMPLOYMENT DATA ( Please use this page for per job detail i.e. C1 to C6) Company Name
Address C1 Telephone Nos. Reporting to Mr. / Ms. His / Her designation
Employment Details: C2
Dates From
To
Duration
years and
Designation C3
Salary (per month) Gross
Net
Directly
Indirectly
On Joining On Leaving
C4
Number of people reporting to you
C5
Job Responsibilities:
#
months
Primary
Secondary
1. 2. 3. 4. 5.
C6
Major achievements during previous employments / advantages you have given to the Company during your term of employment:
1.
2.
3.
* Attach copies in case of more than one organization you have worked with.
C7
Reasons for leaving previous organizations: ( Mention the most recent job first Name of the Organizations
Phone #
Reason
1. 2. 3.
C8
References for cross verification: Name Relationship with respect to your job Contact Telephone Nos.
1. Address
Name Relationship with respect to your job Contact Telephone Nos. 2. Address
D) PERSONALITY PROFILE D1
Kindly tick the box you think you fit in correctly for each trait: Range
1.
Nature
2.
Sensitive & Emotional
Introvert
1
2
3
4
5
6
7
8
9
10
Extrovert
Weak
1
2
3
4
5
6
7
8
9
10
Strong
Ability to focus & concentrate on work / job 3.
3a.
Under routine circumstances
Low
1
2
3
4
5
6
7
8
9
10
High
3b.
Under stress and pressure
Low
1
2
3
4
5
6
7
8
9
10
High
4.
Sincerity
Low
1
2
3
4
5
6
7
8
9
10
High
5.
Hard work
Low
1
2
3
4
5
6
7
8
9
10
High
6.
Honesty
Low
1
2
3
4
5
6
7
8
9
10
High
D2
Strengths (Tick the most appropriate with respect to the position applied for): FEATURES
1.
Knowledge
2.
Skill
3.
Desire
Very Good
Good
Average
Poor
D3
Why, in your opinion, do you think your candidature suits this job?
1. 2. 3.
D4 Q.
Our Company’s HRD philosophy is “To employ & retain only those people, because of whom the Company will grow and not those who will grow because and as the Company grows”. How do you perceive yourself fitting into this Company philosophy and culture? Explain your views.
A.
#
D5
Your Strengths
#
1. 2. 3.
1. 2. 3.
4. 5.
4. 5.
Your Weaknesses
How do you manage your personal life with respect to (Circle the most appropriate): D6
D7
I
II
III
IV
1.
REST
Not sufficient
Just above adequate
Adequate
Lots of rest
2. 3.
EXERCISE RECREATION
Not sufficient Negligible
Just above adequate Once / twice a month
Adequate 2 – 3 times a week
Lots of rest Daily
1.
Level of self - confidence
2.
Ability to accept:
3.
Risk taking ability
4.
Ability to:
5.
Analytical skills
6. 7.
1
2
3
4
5
6
7
8
9
10
a.
Criticism
1
2
3
4
5
6
7
8
9
10
b.
Others views
1
2
3
4
5
6
7
8
9
10
1
2
3
4
5
6
7
8
9
10
a.
Listen attentively to others
1
2
3
4
5
6
7
8
9
10
b.
Follow instructions
1
2
3
4
5
6
7
8
9
10
1
2
3
4
5
6
7
8
9
10
Problem solving skills
1
2
3
4
5
6
7
8
9
10
Logic & reasoning skills
1
2
3
4
5
6
7
8
9
10
E) FUTURE PLANS & OBJECTIVES What are the objectives in life you wish to achieve before you retire?
#
What are your retirement plans (after the age of 60)?
1. E1 2.
3.
#
Your Talents
Your Hobbies
1. 2. E2 3. 4. 5.
F)
F1
EXPECTATIONS FROM THE COMPANY (GEORGE PHILIPS) Where do you foresee yourself to be in the Company hierarchy in the next…
#
Period
Position / Designation
1.
During Probation
2.
On Confirmation
3.
1 Year
4.
3 Year
5.
5 Year
6.
10 Year
F2
Desired salary growth in the Company:
Taking Up of Additional Responsibilities of…
st
rd th
th
#
Stage
Period
1.
Probation
0 – 6 months
2.
Post Confirmation
7 – 12 months
nd
3.
2
Year
13 – 24 months
4.
3 Year
25 – 36 months
rd
Gross Per Month
%age Increase
G) REFERENCES (Other than relations) Mention full addresses & contact nos. Name Designation Company Name G1. Residential / Company Address Contact Nos.
Residential
Office
Residential
Office
Name Designation Company Name G2. Residential / Company Address Contact Nos.
H) GENERAL DATA If selected, when can you join?
H1
Are you prepared to work anywhere in India? If No then state Preferred cities Have you applied to us previously or were you interviewed by us previously? If so, please give details of post applied for and date of interview If selected, can you make your own arrangement for accommodation at the place of posting? Have you been referred to us by anyone? If so, please give details
H2
If so required, would you be in a position to commit a period of time, to continue remaining in employment with the company (Yes / No) : And if so, how many years would you be able to commit to the company. Mention the no. of years :
H3
KINDLY SUBMIT PROOF OF SALARY WHERE LAST EMPLOYED, WITHOUT WHICH THIS APPLICATION BLANK WILL NOT BE ACCEPTED. Is the last salary slip attached to this Application Blank? Yes No DECLARATION
H4
I Hereby declare that the information, furnished above by me is true to the best of my knowledge and belief and understand that any mis-statements and / or suppression of facts will render me liable for immediate dismissal Date
Applicant’s Signature
I1.
Please use this page to write your Application for the Position Applied For in the Company (in your own Handwriting).