Shree Applicant Form

IMS/47/01/FOR/11
Ed-01, Is-01, 15.08.2011
Ankit Mathur
SHREE CEMENT LTD.
Assistant Manager (HRD)| Shree Cement

Mob: +91 9251040309 | Email: [email protected]
APPLICATION FOR EMPLOYMENT

CONFIDENTIAL
[email protected]
I.
Ref. No.
Position
How did you come to know about this vacancy in SCL?
Job Sites
Newspaper advertisement
SCL website
Employment Exchange Reg. No. (if any)
SCL Employee
Placement Agency
Other
Photograph
PERSONAL DETAILS
II.
Name (In Block Letters-As stated in matriculation certificate)
(First Name)
(Middle Name)
(Last Name )
Father's/Husband's Name (In Block Letters)
Date of Birth
Marital Status
Gender
Age
Weight
Religion
Place of Birth
Height
metres/cms
Caste
Category SC/ST/OBC/Gen
Blood Group
Identity
Mark
Passport No.
Body Mass Index

(BMI)
PAN No.
Specify medical illness if any

including Color Blindness
Permanent Home Address
Present Residential Address
House No.
House No.
Apprt./Street
Apprt./Street
Locality
Locality
City/District
City/District
Pin Code
Pin Code
State
State
Contact No.
Contact No.
E-mail Id
Any relative/Known in Shree Cement Ltd.

Name of Relative
Yes /No _____
If yes , details
Department
Location
Relationship
IMS/47/01/FOR/11
Ed-01, Is-01, 15.08.2011
Languages Known
Language
I.
II.
III.
IV.
Speak
Read
Write
ACADEMIC DETAILS
III.
Year
Qualification
[FromTo]
Regular/Private/corr
espondence/parttime
Name of School/collage & Board/University
Passed at
% or CGPA which
attempt
Subject
*please indicate break in studies if any with reasons thereof
Membership of Professional Bodies / Institutes?

Name of Bodies/Institutes
Yes.
No
Membership No.
SKILL SET
IV.
Key Skill
Computer Knowledge
Hobbies
Achievement Summary (If Any):
Membership w.e.f.
IMS/47/01/FOR/11
Ed-01, Is-01, 15.08.2011
PRESENT EMPLOYMENT DETAILS
V.
I. PROFESSIONAL EXPERIENCE
Organization
Address
Nature of Business
Annual
Turnover
No. of employees
(in Group)
No. Of
employee
Date of Joining
Position on
joining
Current Position
Functional
Area
Total Experience
Organization Structure( Write Designation only )
His Superior
Your Superior(Reporting officer).
Your Colleague in dept
You
Your Colleague in dept
No. of employees reporting to you :

Key Responsibilities
Reason for seeking changes :

II. SALARY STRUCTURE (Per Month)-Presnt Employer
At time of
Joining
At time of
Joining
Presnt Structure
Basic/ Consolidated
Drivers
salary/Allowance
Conveyance
Allowance
Business Attire
Children Education
Allowance
Mediclaim/
Insurance
Medical
Reimbursement
L.T.A.
Entertainment
Allowance
Bonus
Dearness Allowances
P.F.
Uniform Maintenance
Superannuation
Soft Furnishing
Allowance
Gratuity
Books & Periodicals
Other Allowance
Any other facility:
Grand Total (All Above)
Expected Salary
Personal Pay
Joining Time Required
Special Allowance
Intensive/Variable pay
Gas/ Electricity
Allowance
Present
Structure
H.R.A./
Accommodation
IMS/47/01/FOR/11
Ed-01, Is-01, 15.08.2011
III. PROFESSIONAL EXPERIENCE (PAST)
Experience -1
Key Responsibility
Name & Address of Employer
Designation on Joining& leaving
Period (From -To)
Reason of Leaving
Last salary Drawn
Experience -2
Key Responsibility
Period (From -To)
Reason of Leaving
Last salary Drawn
Experience -3
Key Responsibility
Period (From -To)
Reason of Leaving
Last salary Drawn
Experience -4
Key Responsibility
Period (From -To)
Reason of Leaving
Last salary Drawn
If the given space is not sufficient, please fill-in extra sheet provided at the end of form.
IMS/47/01/FOR/11
Ed-01, Is-01, 15.08.2011
FAMILY BACKGROUND
VI.
Relation
Name
Age
Occupation
Education
Dependent
REFERENCE DETAILS
VII.
Specify, other than relatives preferably senior executive in any government or private organization.
Reference
Reference II
Name & Full Address
Designation
Organization
Contact No.
OTHER DETAILS
VIII.
If you have appeared for Test/Interview earlier, with Shree Cement , kindly furnish details as below :
Date of Test/Interview
Position
Whether selected & offered employment ?

Foreign stay or travel if any ?
Countries visited
Yes/No
Time Duration
Purpose of Visit
Is any legal proceeding (civil/criminal) pending against you in any court of law or have ever been found guilty by any
court of law ?
Yes/No
If yes, give details of the matter.
I certify that the information furnished above is factually correct and subject to verification by SCL (including reference check and background verification). I
accept that an appointment given to me on this basis can be revoked and / or terminated without any notice/compensation at any time in future if any
information has been false, misleading or deliberately omitted / suppressed. I also certify that I am at present in sound mental and physical condition to
undertake employment with SCL.
Place
Date
Signature of applicant
IMS/47/01/FOR/11
Ed-01, Is-01, 15.08.2011
IX.
EXTRA SHEET FOR WRITING PROFESSIONAL EXPERIENCE (PAST)
Experience -5
Key Responsibility

Period (From -To)
Reason of Leaving
Last salary Drawn
Experience - 6
Key Responsibility

Period (From -To)
Reason of Leaving
Last salary Drawn
Experience -7
Key Responsibility

Period (From -To)
Reason of Leaving
Last salary Drawn
Experience -8
Key Responsibility

Period (From -To)
Reason of Leaving
Last salary Drawn

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IMS/47/01/FOR/11

Ed-01, Is-01, 15.08.2011

SHREE CEMENT LTD.

Assistant Manager (HRD)| Shree Cement

APPLICATION FOR EMPLOYMENT

How did you come to know about this vacancy in SCL?

Father's/Husband's Name (In Block Letters)

Body Mass Index

Specify medical illness if any

Permanent Home Address

Present Residential Address

Any relative/Known in Shree Cement Ltd.

Yes /No _____

Name of School/collage & Board/University

*please indicate break in studies if any with reasons thereof

Membership of Professional Bodies / Institutes?

PRESENT EMPLOYMENT DETAILS

Your Superior(Reporting officer).

Your Colleague in dept

Your Colleague in dept

No. of employees reporting to you :

Reason for seeking changes :

Books & Periodicals

Any other facility:

Grand Total (All Above)

Joining Time Required

Name & Address of Employer

Designation on Joining& leaving

Period (From -To)

Last salary Drawn

Name & Address of Employer

Designation on Joining& leaving

Period (From -To)

Last salary Drawn

Name & Address of Employer

Designation on Joining& leaving

Period (From -To)

Last salary Drawn

Name & Address of Employer

Designation on Joining& leaving

Period (From -To)

Last salary Drawn

Name & Full Address

Whether selected & offered employment ?

EXTRA SHEET FOR WRITING PROFESSIONAL EXPERIENCE (PAST)

Name & Address of Employer

Period (From -To)

Last salary Drawn

Name & Address of Employer

Period (From -To)

Last salary Drawn

Name & Address of Employer

Period (From -To)

Last salary Drawn

Name & Address of Employer

Period (From -To)

Last salary Drawn

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