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I -: EMPLOYMENT FORM :-
I FORM NO.:2 - 400 067.
PHONENo.:-28609011 (4L1NESI.FAX:-28609734 PLOT NO. 134 AlB, FIRST FLOOR, GOVT. INDUSTRIAL
ESTATE, KANDIVLI (WEST), MUMBAI
1) To be filled in by Applicant's own handwriting. 2) Tick (...;) appropriate box as applicable. POST APPLIED FOR :-
AFFIX RECENT PHOTOGRAPH
1. PERSONAL HISTORY :a) NAME :- Mr. IMs. :-
(Surname)
(First Name)
(Father's/Husband'sName)
b) PermanentAddress:-
c) Contact Address :-
(1\ Dhone No. (Resi.) :e) Date of birth :f) Marituaf Status:Married ( )
(C&!I)
Other AGE :- (Next Birthday) :-
Single ( )
Name
Other (Specify)
( )
2. FAMILYDETAILS :Relationship Father Mother Age Qualification Occupation h
8
Brother's
Sister's
Husband Mlife Children
2.
...
-23. HEALTH INFORMATION :a) How would you rate your present Health? b) In your rate your present state of health would you consider yourself incapaciated for any Job I activities? c) Do you wear glasses? d) Height :e) Weight :4. HOME TOWN :5. NATIONALlTY:6. RELIGION :- . 7. PROVIDENT FUND MEMBERSHIP
~ORM NO. :21 : Poor ( ) : Yes ( )
: Yes ( ) Fair () No ( ) No ( ) Good ( )
If yes, for reading only or always?
: Yes ( ) : Number :-. No ( ) : Yes ( ) : Number :-. No ( ) : Yes ( ) : Number :-. iJo ( )
8. FAMILYPENSION FUND :-
9. E.S.I. .10. LANGUAGES:MOTHER TOUNGUE: OTHER: 11 QUALIFICA T~~NS :Examination Passed I Degree or Diploma Obtained
Year of Passing
Class of
IPrincipal Sub.
I .
School/CollegE
Institute
Universi
Degree IDiploma
Studied
i\
e
Institution
12 SHORT TERM & PART-TIME SPECIALISED COURSES I TRAINING PROGRAMES ATTENDED. Place'" Year Period of Attendence Description of Cource Certificate Awarded
OJ -.
-3Have you ever been prosecuted in a Criminal Court ? If so, give details and results of the preosucution ? 14. REFERENCES :Give two references (other than relatives). Please ensure that they have known you well personally & professionally. We shall writing to each one of them for a reference.
I FORM NO..:~ I
'13. LEAGALACTION (if any) :-
Name
Designation
Address
Period for which he/she knows you
capacity in whiCh he/she knows you
8
l1. 1 i~einformation given by me in this form is true to the best of my knowledge and belief.
2. Ifany informationis found false, I myselfshall be held res )onsiblefor any legal and other consequences.
My services are also liable to be terminated without.notic!!.
Date :Place :Signature
-: FOR OFFICE USE ONLY :1. Interviewed on :2. Interviewed by :a) Name: b) Designation:c) Signature :3. Selection Approved/Rejected by :4. Salary Offered :5. Designation :6. Dept. I Place of Work :-
Remarks :-
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