ADDRESS: 17806 West IH

10, Suite 405

San Antonio, TX 78257
Phone: (908) 834-3381

Employment Application Form.

Thank you for your interest in Gulftex Energy.. This form is intended to enable you to record important points
about yourself, your experience, your achievements and your plansforthe future. Please complete the form in full
and use additional sheets if necessary. When we meet you at the interview, the contents of this application will
provide a base for our interaction.

PERSONAL INFORMATION

First Name RAKESH Middle Name Last Name KUMAR Kind

Mr./Ms.: ( Expand all names)

Date of Birth
e-mail:
1 0 0 3 1 9 9 5
Current Address:

City: BEGUSARAI State: BIHAR PIN Phone (with Office

STD code)
8 5 1 1 0 1 Res.
Permanent Address:
City: BEGUSARAI State: BIHAR PIN Phone (with STD code)
8 5 1 1 0 1 Mobile 8 2 4 0 9 4 6 3 8 2

EDUCATION
(Begin with the most recent qualification and end with Std. X)
Course/Degree Specialization Name of Institute /University Address Graduation Aggregate
GNIIT software National Institute of KOLKATA WEST BANGAL (Month/Yr.) Marks
engineering Information Technology INDIA 2016 76% or CGPA)

Employment Application Form 1

TRAINING
Training/Development Programmers attended / Skills acquired Institute / Organization Location Dates attended

From To

WORK EXPERIENCE
Number of Companies Worked for (Count should include the Present Employer) ……….
CURRENT EMPLOYMENT
Name of the Employer: Address:

Phone:
Number of Employees: Sales Turnover:

Date Employed From To Notice Period :1-2 month

Your Designation & Department: Employee Responsibilities:
Code-

Reason for Leaving:

Supervisor’s Name & Designation, EMAIL ID & Contact Number:

Can we take reference from your supervisor? ☐ Yes ☐No

Deputation Details :( Mention name of organization to whom you were deputed

through current employer Please mention NA if not applicable)

MONTHLY EMOLUMENTS
Fixed Salary Variable / Perks Deferred benefits
Basic Housing PF, Pension, Gratuity etc. (C)

Bonus/Incentives Company car

Allowances Furnishings Monthly Gross (A+B+C)

Others
LTA (/ p.a.) Others Variable (……./p.a)
Current Annual Gross
Food Coupons (please specify)
(please specify)
Total (A) Total (B) Expected Annual Gross

If yes, Nett gain at current value :

Do you have employee stock options? ☐ Yes ☐No
{(Current Market Price – Issue price) x No. of stocks}
PREVIOUS EMPLOYMENT
Name of the Employer: Address:

Dates Employed: FROM TO Phone:

Your Designation & Department: Employee Code Responsibilities:

Reason for Leaving:) Monthly Gross:

Supervisor’s Name & Designation, EMAIL ID & Contact Number

Name: -Designation: - Group Leader Email: -

Deputation Details :( Mention name of organization to which you were deputed

through current employer. Please mention NA if not applicable)

Employment Application Form 2

ALL OTHER PREVIOUS EMPLOYMENT DETAILS
Name of the organization Location Designation Employee Duration Monthly Salary Reason for
Code Leaving
From To Starting Final

ABOUT YOURSELF
The answers to the following questions will help us get a better understanding of you as a person.
Your personal strengths? Your personal areas of improvement?

Your career objectives? Your expectations fromGulftex Energy.?

SIGNIFICANT ACHIEVEMENTS:

OTHER INTERESTS: Cultural, sports, community work and hobbies from school onwards & details of memberships of association

REFERENCES
Give references under whom you have either worked or who know you professionally for at least 6 months.
Name Duration & Organization & Designation e-mail Phone (with code)
Nature of Home Office
Association

ADDITIONAL DETAILS
If Others, Specify Nationality:
Nationality ☐American☐ Others
Do you have work permit to work in American ? ☐ Yes
☐ No
If Yes, PassportNo:
Do you hold a valid Passport? ☐ Yes ☐No
(for Canadian citizens only)
Valid till:
If Yes, Details
Have you been denied VISA to any country? ☐ Yes ☐ No

If yes, provide details on countries visited and type of Visas held

Have you worked on overseas assignments? ☐ Yes ☐ No

Have you attended any selection process at ☐ Yes ☐ No If Yes, Division: Location :
Gulftex Energybefore? Month/Year: Status :
Do you have any relative / friend employed? If Yes, his/her name:
WithGulftex Energy? ☐ Yes☐No Division/Location:
If Yes, Details
Have you suffered from any major illness?
/surgery /accident in the last five years? ☐ Yes ☐No

Employment Application Form 3

 Have you ever been arrested, prosecuted or convicted for any criminal If Yes, furnish details including type of offense and conviction
offense, other than minor traffic offenses ? ☐ Yes ☐No
Yes ( ) NO ( )
In the last ten years, have you been convicted of or plead guilty to any
offence?☐ Yes ☐No Yes ( ) NO ( )

In the last ten years have you been released from prison on a
conviction? ☐ Yes ☐No

Do you have any commitment to another employer or organization that might affect your employment with us? ☐ Yes ☐ No

Any other information you would like us to know which may have significant bearing on our hiring decision:

WORK LOCATIONS
Are you willing to be posted anywhere in American ? ☐ Are you willing to be posted abroad? ☐ Yes ☐ No
Yes ☐No
Indicate your preferred work location in American :

DECLARATIONS
1. I hereby declare that my statements on this form and on my resume or documents provided by me to Gulftex Energyare true and correct
to the best of my knowledge.
2. I understand that Gulftex Energyat its discretion, may institute and conduct a background check to verify the information furnished by me
Gulftex Energyassures me that
in this form. background check on my current employment will be taken up only post my joining
Gulftex Energyand this is acceptable to me.
3. I authorize all persons who may have information relevant to the verification to make disclosures to Gulftex Energyor its representatives/
agents.
4. I acknowledge and agree that providing any false information may result in a decision not to hire me or if hired, may result in termination of my
employment.
5. I understand that Gulftex Energymay notify and publish any information provided by me that is found false. In addition, I understand and
Gulftex Energyhas rights to seek any legal remedies
agree that including indemnification and damages from me for any loss caused to
Gulftex Energyas a result of any such false information.
Date: 1/06/21 Place: BEGUSARAI Job position:Name:

Signature: RAKESH KUMAR

Employment Application Form 4