Company Application Form

APPLICATION FOR EMPLOYMENT
Applicants May Please Note That:

a. The object of the data sheet is to obtain as much
information as possible about you before a personal
meeting.
b. All the details furnished will be treates as
Affix Passport Size CONFIDENTIAL and we expect you to be free and
Photograph frank in disclosing details. Furnishing incorrect
here. or concealing material data will affect your
candidature
c. Write in clear block letters in your own hand; use
separate sheets where space provided is not
sufficient; DO NOT attach original documents.
POSITION APPLIED FOR
PERSONAL DATA
1 Mr./Mrs./Miss PAUL GEETASHREE _______________

SURNAME FIRST MIDDLE
2 Address
55, SANTRAGACHI STATION ROAD, G.I.P COLONY, JAGACHA,
a) Mailing : HOWRAH-711112, NEAR INDIA SWEETS Phone: 6289008253
b) Permanent: 55, SANTRAGACHI STATION ROAD, G.I.P COLONY, JAGACHA, Phone:

HOWRAH-711112, NEAR INDIA SWEETS 6289008253
c) Email Id : Mobile:
[email protected] 6289008253, 8017773139
Date of Birth Place of Birth State of Domicile
3 Age:
10.11.1993 DUMDUM WEST BENGAL
4 Height 5FT 2 INCH Weight: 77 KGS Marital Status: UNMARRIED Nationality: INDIAN
5 Family Background Name Age Occupation Name of Employer
Father GOURANGA CH. PAUL 59 BUSINESS

Mother MUKTA PAUL 50 HOMEMAKER
Wife / Husband
Brothers / Sisters
Son/s
Daughter/s
6 Other Dependents
* Revised w.e.f. June 01, 2016 Page 1

7 EDUCATION AND TRAINING
Degree/ Diploma/ Certificate Class / Names & Location of last From To Major Subject
(Highest Degree/ Diploma first) percentage Univ/College/ High School Mon/Yr. Mon/Yr.
attended
8 Details of Distinctions, Scholarship, Prize Won, Positions held
9 Extra-Curricular activities at school, College etc./
10 Specialised Training, Other Qualifications, etc
Degree/ Diploma/ Certificate Name and Location of Institute From To Details of Course
Mon/Yr. Mon/Yr.
11 Other Skills
12 Special Interest
13 Employment Account for ALL your time since Leaving High School or College and Period of Employment, Full or part-
time, during College and thereafter, if more space is required, use a separate sheet of paper, Start with your present or
most recent employment and work back to the first position and account for all periods of Unemployment
Present Previous History

Employer’s Name & Location
From
Period Worked
To
Start
Designation
Leaving
Nature of Work
Total Emoluments Basic :

DA
HRA
HMA
ED.Allw
Conv. Allw
CCA
Tel
LTA
MED
PF
Gratuity
SA
Bonus
Any Others
Monthly
Total
Revised w.e.f. June 01 , 2016 Page 2

OTHER DATA
14 Details of membership of Professional /Social / Culturual Bodies
15 Give details of Publications Significant Participation in Symposia etc.
16 Languages known Language Speak Read Write
ENGLISH Y Y Y
BENGALI Y Y Y
HINDI Y Y Y
17 Are you connected with any Buisness Yes / No
i) If yes, please give particulars
ii) Do you have any other business interest that might create an actual or potential, conflict of interest
or any situation which would interfere with your employment with company Yes / No
If yes, please give particulars
18 a. Do you have any permanent physical disability ? Give Details
b. Have you had any major illness or operation in the last three years ?
19 Are you in a position to make your own Housing arrangements in Mumbai ? Yes
No
20 a. Are you prepared to serve anywhere in : India Y Abroad Y
b. Joining time required , if selected : 1 MONTH
21 Do you have any friends working in Jacobs. Specify full name, department and employment number NO
Revised w.e.f June 01, 2016 Page 3

Revised w.e.f June 01, 2016 Page 3
GENERAL
22 Do you have any relatives working in Jacobs. Specify full name, department, employment number
and relation.
23 Who referred you to Jacobs ?. Name -
a) Is the Person who referred you is a Jacobs Employee : Yes / No

b ) If No , is the person involved in any dealings with Jacobs. Please elaborate.
Have you ever served in any of the Jacobs Entity Or have you previously applied for
24 work with Jacobs ? With what result ?
25 Are you an Ex- Govt Official, if yes, give details Yes / No
If yes, please provide
i) Give details of your employement as Public Official
ii) Please confirm if you have served the requisite cooling period as required by your previous
Employer Yes / No
If yes, please provide details of any restrictions on your employment with Company.
iii) If you have been personally and substantiallly involved in any bid, procurement process
or project with Company in the past 2 years, If yes, please provide detials.
Please provide us with a copy of the release letter issued by the Government
department you were previously employed by.
26 Have you been convicted for criminal record ? Yes________ No __________
27 Are you a Close Relative of a Public Official or an Ex Public Officer? Yes / No
If yes, please provide
i) details of your relationship with the Public Official?
ii) details of the Public Official (i.e. name, designation and government department with whom the
Public Official is employed)
Revised w.e.f. June 01, 2016 Page 4

GENERAL
28 Have you been terminated by your past Employer ? Yes_____________ No __________
29 State reasons as to why consider yourself suitable for the position applied for
30 Are you under any bond ? Give details
31 What is the outstanding accomplishment of your career ?
32 Please utilise this space for adding any other factual information that you think is relevant
33 REFERENCES :(Two Reference closely acquainted with you but MUST Not be your relations)
a Name : Dr. Shriniwas Arkatkar b Name : Dr. Gaurang Joshi
Address : SVNIT Address : SVNIT
Phone : _ 8140252777 Phone : 9879564862
Occupation : Occupation :
I hereby declare that all the statements made in my application and the documents submitted in support thereof are true,
complete and correct to the best of my knowledge and belief. In the event of any information being found false or incorrect
at any stage, my application is liable to be rejected and if already appointed, my services are liable to be terminated
Please Note:We would conduct a background verification check through a third party vendor for all the documents
provided by you.
Name: GEETASHREE PAUL Place KOLKATA
Date : 15.02.2021
Revised w.e.f. June 01, 2016 Page 5

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APPLICATION FOR EMPLOYMENT

Applicants May Please Note That:

POSITION APPLIED FOR

1 Mr./Mrs./Miss PAUL GEETASHREE _______________

b) Permanent: 55, SANTRAGACHI STATION ROAD, G.I.P COLONY, JAGACHA, Phone:

Father GOURANGA CH. PAUL 59 BUSINESS

* Revised w.e.f. June 01, 2016 Page 1

8 Details of Distinctions, Scholarship, Prize Won, Positions held

9 Extra-Curricular activities at school, College etc./

10 Specialised Training, Other Qualifications, etc

Present Previous History

Total Emoluments Basic :

Revised w.e.f. June 01 , 2016 Page 2

14 Details of membership of Professional /Social / Culturual Bodies

15 Give details of Publications Significant Participation in Symposia etc.

16 Languages known Language Speak Read Write

17 Are you connected with any Buisness Yes / No

i) If yes, please give particulars

If yes, please give particulars

18 a. Do you have any permanent physical disability ? Give Details

20 a. Are you prepared to serve anywhere in : India Y Abroad Y

b. Joining time required , if selected : 1 MONTH

Revised w.e.f June 01, 2016 Page 3

23 Who referred you to Jacobs ?. Name -

a) Is the Person who referred you is a Jacobs Employee : Yes / No

25 Are you an Ex- Govt Official, if yes, give details Yes / No

If yes, please provide

i) Give details of your employement as Public Official

department you were previously employed by.

26 Have you been convicted for criminal record ? Yes________ No __________

27 Are you a Close Relative of a Public Official or an Ex Public Officer? Yes / No

If yes, please provide

i) details of your relationship with the Public Official?

Public Official is employed)

Revised w.e.f. June 01, 2016 Page 4

28 Have you been terminated by your past Employer ? Yes_____________ No __________

30 Are you under any bond ? Give details

31 What is the outstanding accomplishment of your career ?

a Name : Dr. Shriniwas Arkatkar b Name : Dr. Gaurang Joshi

Address : SVNIT Address : SVNIT

Phone : _ 8140252777 Phone : 9879564862

Name: GEETASHREE PAUL Place KOLKATA

Revised w.e.f. June 01, 2016 Page 5

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26 Have you been convicted for criminal record ? Yes No __

28 Have you been terminated by your past Employer ? Yes___ No