CENTURY TEXTILES & INDUSTRIES LTD.

(CEMENT BUSINESS GROUP) CENTRAL RECRUITMENT CELL

To be filled in by the applicant in his own words clearly and carefully.

OFFICE REFERENCE NO. EMPLOYMENT EXCHANGE NO. POST APPLIED FOR: FULL NAME IN BLOCK LETTERS:
(SURNAME) (NAME)

DATE: DATE:

(MIDDLE)

FATHER'S NAME: HOW DO YOU WANT YOUR NAME TO BE WRITTEN: PRESENT MAILING ADDRESS: PIN PERMANENT HOME ADDRESS: TEL NO.

PLEASE AFFIX YOUR RECENT PHOTOGRAPH PASSPORT SIZE

PIN AGE(YRS)
(YEAR) (MONTH) (DAY)

TEL NO. BIRTH PLACE STATE

NATIONALITY

RELIGION

SC/ST

BLOOD GROUP

PERIOD OF STAY IN A STATE FOR FIVE YEARS OR MORE WITH ADDRESSES:

1 2 3
A. P E R S O N A L D A T A

4
TYPE OF PRESENT ACCOMODATION:
OWN RENTAL
WITH RELATIVE

COMPANYS

MON RENTAL

MARITAL STATUS:

SINGLE/ MARRIED/ SEPERATED/ DIVORCED NAME DATE OF BIRTH AGE RELATION OCCUPATION SHIP WHETHER STAYS WITH YOU YES YES YES YES YES YES NO NO NO NO NO NO

DETAILS OF FAMILY MEMBERS AND DEPENDENDENTS

LANGUAGE LANGUAGES KNOWN (UNDERLINE MOTHER TONGUE)

SPEAK

READ

WRITE

B.

EDUCATION
EXAMINATION PASSED SUBJECT SPECIALISATI ON WHETHER FULL TIME/ PART TIME/ CORRESP DURATION SCHOOL/COL OF COURSE LEGE/INSTITU TTION GRADE % MARKS YEAR OF PASSING DEGREE/ DISTINCTION/ DIPLOMA SCHOLORSHI CERTIFICATE PS/ PRIZES WON

S.S.C or equivalent

12th/HSC or equivalent

DIPLOMA CERTIFICATE

C.

DEGREE(S) MEMBERSHIP OF PROFESSIONAL INSTITUTIONS

PERIOD

FROM

TO

NATURE OF THE TRAINING COURSE

DURATION

YEAR

INSTITUTE/ ORGANISATION

CERTIFICATE AWARDED

D. TRAINING

E. PAPERS PUBLISHED/ PRESENTED

TITLE

NAME & DATE OF THE SEMINAR / JOURNAL IN WHICH PRESENTED / PUBLISHED

F. EXTRA CURRICULAR ACTIVITIES

ACTIVITY

INSTITUTION/ ASSOCIATION/ SOCIETY/ CLUB

YEAR

POSITION HELD

PRIZES WON

HEIGHT

WEIGHT

POWER OF GLASSES

PHYSICAL DISABILITY IF ANY

MOST RECENT SERIOUS ILLNESS

FROM

TO

NO OF DAYS

PHYSICAL DISABILITYIF ANY

G. HEALTH DATA

OTHER MAJOR ILLNESS / MAJOR OPERATIONS & DURATION

EMPLOYMENT HISTORY In unbroken chronological order starting from first employment till date. (Please account for all the periods of time not covered by education / training)

Employer's Name & Address From

Duration To Last

Joined As Present Designation Designation

Nature of Duties

Gross Emoluments At the time of joining Last Drawn

H. EMPLOYMENT PARTICULARS IF APPLICABLE

DRAW IN BRIEF THE ORGANISATION STRUCTURE WHERE YOU ARE PRESENTLY EMPLOYED INDICATING TWO LEVELS ABOVE & ONE LEVEL BELOW YOUR POSITION:-

SIGNIFICANT ACHIEVEMENTS, MENTION SOME OF THE MAJOR CONTRIBUTIONS MADE BY YOU IN YOUR PRESENT & PREVIOUS JOBS:-

I. EXPLAIN WHY YOU CONSIDER YOURSELF SUITED FOR THE POSITION:-

HAVE YOU EVEN BEEN INTERVIEWED BY ANY UNIT OF THE CENTURY GROUP YES NO DATE YEAR POSITION COMPANY ADDRESS

(IF YES, GIVE DETAILS)

J. REFERENCES

RELATIVES / ACQUAINTANCES IN CENTURY GROUP OF COMPANIES NAME RELATIONSHIP POSITION COMPANY & ADDRESS

NAME & ADDRESSES OF TWO REFERENCES (NOT RELATIVES

K. DETAILS OF CURRENT EMOLUMENTS IF ANY: APPLICANT'S NAME

PRESENT EMPLOYERS NAME POSITION HELD

SL. NO

EMOLUMENTS PARTICULARS YEARLY (RS./YEAR) MONTHLY(RS./MONTH) PRESENT EXPECTED PROPOSED

1 BASIC

2 DEARNESS ALLOWANCE OR EQUIVALENT

3 HOUSE RENT ALLOWANCE

5 CITY COMPENSATORY ALLOWANCE

6 SALES COMMISSION

7 INCENTIVES IF ANY

8 ANY OTHER (PLEASE SPECIFY)

9 SUB TOTAL

MONTHLY EMOLUMENTS

4 CONVEYANCE/ TRANSPORT ALLOWANCE

SL. NO 10 BONUS( %)

EMOLUMENTS PARTICULARS YEARLY (RS./YEAR) MONTHLY(RS./MONTH) PRESENT NNUAL BENEFITS EXPECTED PROPOSED

11 LEAVE TRAVEL ALLOWANCE 12 ANY OTHER (PLEASE SPECIFY)

13 SUB TOTAL 14 PROVIDENT FUND ( 15 SUPERANNUATION 16 GRATUITY 17 SUB TOTAL 18 GRAND TOTAL 19 A. HOSPITALISATION B. DOMICILIARY C. ANY OTHER (SPECIFY) HAVE YOU SIGNED ANY CONTRACT WITH PRESENT EMPLOYER? IF SO, PLEASE GIVE DETAILS: %)

20

L: SERVICE AGREEMENT: ARE YOU AGREEABLE TO SIGN SERVICE AGREEMENT AS PER COMPANY STANDARD FORM FOR FIVEYEARS

M: WHEN CAN YOU JOIN:

N: DECLARATION: I HEREBY DECLARE THAT ALL THE FOREGOING INFORMATINO IS CORRECT TO THE BEST OF MY KNOWLEDGE AND BELIEF AND NOTHING HAS BEEN CONCEALED. I AM NOT AWARE OF ANY CIRCUMSTANCES WHICH MIGHT DECLARE ME UNFIT FOR EMPLOYMENT. IF AT ANY TIME, I AM FOUND TO HAVE CONCEALED ANY MATERIAL INFORMATINO OR GIVEN ANY FALSE DETAILS, MY APPOINTMENT SHALL BE LIABLE TO SUMMARY TERMINATION WITHOUT NOTICE OR COMPENSATION.

DATE PLACE SIGNATURE

FOR OFFICE USE ONLY

HELD ON..

1 CHAIRMAN 2 MEMBER 3 MEMBER 4 MEMBER 5 MEMBER

:
: : : :

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MEDICAL REIMBURSEMENT LIMIT

INTERVIEW

SOCIAL SECURITY BENEFITS

AN

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CHAIRMAN

MEMBER

MEMBER FINAL SELECTION

MEMBER

MEMBER

DATE__________________

PRESIDENT