COOPER CORPORATION PVT. LTD.

NARIMAN HOUSE, M60-1, Addl. MIDC, Post Kodoli, Satara 415 004.

Employment Application Form

(Instructions: Please fill in the form& do not leave any sections incomplete. Part B must be filled in your own
handwriting)
Please affix
here your
Position Applied For: ______________________________________________
recent
Location: ______________________________________________________ passport size
photograph
Personal Details

FULL NAME (in Block Letters):

Residential Address

Present Address Permanent Address

Cell No: Tel No. (with STD code):

E-mail i.d (if any)

Languages Known English Hindi Marathi Other

Date of Birth: Place of Birth: Male / Female :

Marital Status: Nationality: Domicile State:

Cast:
Religion: (Company does not believe in any Describe Physical Defect if Any:
discrimination ,details required for data
on Social inclusion)

Present CTC ( P.A) Expected CTC (P.A.)

Compensation

Are you ready to work anywhere in India? Yes No.

When can you join if selected ? .

Do you have any interest,Financial or otherwise in any business? Yes No

Do you own a conveyance? Yes No 2 Wheeler/ 4 Wheeler / None.

(If required,can you arrange one out of your own resources? )

If outstation candidate,can you arrange your own accomodation? Yes No.

If require are you ready to sign a bond? Yes No.

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 COOPER CORPORATION PVT. LTD.
NARIMAN HOUSE, M60-1, Addl. MIDC, Post Kodoli, Satara 415 004.

Employment Application Form

Are you resident of Satara? Yes No.

Family Background
Relation Name Age (yrs) Occupation
Father

Mother
Family Details

Brother

Sister

Spouse

Children

Height: cms Physical disability (If any): Blood Group:

Weight: Kgs

Major Illness / Operation within last 3 years (If YES, Please give details)

Academic Background
(Start from your last qualification)
Degree / Diploma / University / Month & Year of Class / Grade (with % of
Professional Institute Passing marks)
Education Back ground

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 COOPER CORPORATION PVT. LTD.
NARIMAN HOUSE, M60-1, Addl. MIDC, Post Kodoli, Satara 415 004.

Employment Application Form

Record of Employment (Starting from the first job)

Period CTC / Reason for
Sr.
Name of the Company & Place Designation Annum leaving/ wishing to
No Form To Drawn leave

1. Professional Achievements (Significant Professional contribution in last two years)

2. What creative or imaginative work you have done in last 12 months?

PROFESSIONAL REFERENCES (Persons mentioned should hold a responsible professional position and should not
be a relative or friend. Preferred references are those whom you have reported /with whom you have worked / working, give
minimum three references. Fresh candidates should give references of their lecturers /Professors only.)

Reference Name Mobile No. Company Designation

Relatives / Acquaintances working with Cooper

Name Relationship Position/Location

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 COOPER CORPORATION PVT. LTD.
NARIMAN HOUSE, M60-1, Addl. MIDC, Post Kodoli, Satara 415 004.

Employment Application Form

Career Focus
a) In which c) If placed there, against
Department/Function would what quantifiable targets after
you like to make a career, one year, should your
b) For Choice No.
name? Three in order of performance be judged?
1. Career Focus I) give you detailed
preference: -
reasons
i)
ii)
iii)
2. Recent a) Technical b) Managerial c) Attitudinal (Behavioral)
Learning : What has
been your major
learning, please give
details.

3. Further Learning a) Technical b) Managerial c) Attitudinal (Behavioral)

Career Focus

(in next 12 months)

planned:
4. Personality a) What are your 3 major b) What aspects of c) What Personality
Development strengths? personality would Development would you like
you like to to undertake in next 12
improve? months?

Have you applied to/interviewed by us earlier? If YES, Please mention the Position applied for, year &
final outcome.

What is the nature of Job you enjoy most?

Why do you seek a job change?

How did you come to know about this opening/Vacancy?

Have you ever been involved in any Criminal proceedings / court cases or been convicted of any offence? If
Yes, Please give details.

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 COOPER CORPORATION PVT. LTD.
NARIMAN HOUSE, M60-1, Addl. MIDC, Post Kodoli, Satara 415 004.

Employment Application Form

[Part B]
29. Please explain in brief why you consider yourself suitable for
position applied? (Must write minimum half page in own handwriting and submit it in original, at the
time interview; in case this form is emailed).

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 COOPER CORPORATION PVT. LTD.
NARIMAN HOUSE, M60-1, Addl. MIDC, Post Kodoli, Satara 415 004.

Employment Application Form

30. Brief Introduction about Yourself?

(Must write minimum full page in own handwriting and submit it in original, at the time interview; in case this
form is emailed).

Signature (sign at all three places)

1]
2]
3]
I hereby declare that all the information mentioned above is true to the best of my knowledge & I understand that any
false information, misrepresentation or omission of facts called for in this application, or other company records, may
result in my immediate dismissal without any notice or pay lieu thereof, even if subsequently e mployed.
Signature of the Applicant: _________________________________________
Date: ________________ Place: ______

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