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Application Form - 144

This document appears to be a job application form that collects personal details such as name, contact information, education history, work experience, computer skills, expected salary, and references. It requests information like date of birth, marital status, gender, qualifications, current and previous employment, languages known, and family details. Health, address, criminal history, and notice period are also addressed. The applicant is asked to declare that all information provided is true.

Uploaded by

Pankaj Salunkhe
Copyright
© © All Rights Reserved
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
38 views

Application Form - 144

This document appears to be a job application form that collects personal details such as name, contact information, education history, work experience, computer skills, expected salary, and references. It requests information like date of birth, marital status, gender, qualifications, current and previous employment, languages known, and family details. Health, address, criminal history, and notice period are also addressed. The applicant is asked to declare that all information provided is true.

Uploaded by

Pankaj Salunkhe
Copyright
© © All Rights Reserved
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
You are on page 1/ 6

Interview Date Time No

First AFFIXYOUR
Second PASSPORT–SIZE
Deviation Letter PHOTO HERE
(If Any)
DOJ
(dd/mm/yyyy)

APPLICATIONFORM
(Fill with neat handwriting/typing) DATE:21-Sep-19

POST APPLIED FOR:

FULL NAME:
(In block letters)
APPLIED WITH REFERENCE:
(Recruiter’s Name)

MobileNo.

Email ID/ Skype ID

DateofBirth
MaritalStatus
Gender
Aadhar Card (Yes / No)
Passport (Yes / No)
General/SC/OBC/ST/If Others (Specify)

Have you been interviewed by us? (Yes / No)


If yes, please specify date of interview
Do you know any of our employees? (Yes / No)
If yes, please specify name & relationship:
Are you pursuing/ planning any further (Yes / No)
educational course? If yes, please specify

QUALIFICATION DETAILS: (Start with Latest Qualification)


Qualification Specialization School /College / Yearof %/ Mediumof Full/Distance
University Passing Grade Education Part Time /

P a g e 1|6
MENTION THE APPROPRIATE OPTION YES / NO

Open to Field work

Open for travelling for Exhibitions / Seminars in INDIA

ABROAD
Addictions Tobacco
Smoke
Alcohol
PHYSIOLOGICALINFORMATION:
BloodGroup Height Weight

Health Issues: BP DiabetesMigraineOthers(If Yes, Please specify below)

Physical disabilities (If Yes, Please specify)

ADDRESS DETAILS:

CURRENT ADDRESS/PERMANENT ADDRESS NATIVE ADDRESS

Residence Address: Native Place:


City/ District/ Village:
PinCode:
State:
Landmark:

LANGUAGESKNOWN:
Languages Speak Read Write

MotherTongue:-

FAMILY DETAILS:
FirstName MiddleName LastName DateofBirth Relationship Occupation

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COMPUTER/ SOFTWARE PROFICIENCY:

* TICK “ ” IF YOU KNOW &“X“IF YOU DO NOT KNOW IN SKILL CHECK BOX
* IF YOU KNOW THEN MENTION THE DETAILS IN GIVEN RESPECTIVE COLUMNS.
SOFTWARE SKILL * VERSION/ TYPE BASIC ADVANCE
MSWORD 
MS EXCEL 
MS OUTLOOK 
MS POWERPOINT 
INTERNET 
TALLY 
PHOTOSHOP 
CORELDRAW 
AUTO CAD 
ANSYS 
CREO PARAMATRIC/ PRO ENGINEER 
CATIA 
DRAFT SIGHT 
SOLID WORKS 
SOLID EDGE 
TURBO CAD 

OTHER (PLEASE SPECIFY)

Is there any criminal/civil/legal cases;


1). Filed by you till now
Yes  (If yes, give details below) No 

2). Filed against you till now


Yes  (If yes, give details below) No 

3). Have you been convicted,


arrested, prosecuted, fined by Yes  (If yes, give details below) No 
any court of law against you

I herebydeclarethatalltheinformationgivenbyme is true. In case,any of the information is found to be


incorrect then company can take action against me including termination

NAME: SIGNATURE & DATE:


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DETAILSOF PRESENT&PREVIOUS ORGANIZATIONS
(StartwithCurrentEmployer)

Employment Period Salary Reasonfor


CompanyName Designation Location Drawn Leaving
From To
(CTCPer
(MM/YY) (MM/YY) Annum)

CURRENTJOBDESCRIPTION:


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CurrentFixed- CTC p.a.: CTC p.m.: Take Home p.m.:

Variable Pay - p.a.: VariablePay p.m.: Variable PayReceived:


(In Current FY)

Expected - CTC p.a.: CTC p.m.: Take Home p.m.:


(Fixed + Variable)

Notice Period :
*(Variable Pay denotes yourIncentives, Performance Pay, Commission etc...)

CURRENTSALARYBREAK-UP

Details of Break-up Monthly


Basic
HRA
Conveyance Allowance
Medical Allowance
Education Allowance
Special Allowance
+
+
+
Gross Per Month
Other Allowance
Bonus
LTA
Leave Salary
CompanyContributiontoPF
Gratuity
Incentive
+
+
+
+
Monthly CTC

Income fromanyother source?If yes,please specify:


1.

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References:

Please listtwo personsfrom recent employer.

Sr.
Name & Designation of Person Organization Official Contact Details
No.
Landline No: -

Mobile No. :-
1

Email Id :-
(Reporting Manager)

Landline No: -

Mobile No. :-
2

Email Id :-
(HR Department)

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