APPLICATION FORM

FOR THE POST OF: ………………………………………………………

NAME OF THE APPLICANT: ……………………………………………

ULTRATECH CEMENT LIMITED

(Unit: Jharsuguda Cement Works)
Near Dhutra Railway Station
Po. Arda, Dist. Jharsuguda (Odisha)-768202

DIRECT RECRUITMENT SCHEME

ADITYA BIRLA GROUP

(To be filled in by the applicant in his/her own handwriting clearly and completely)
Paste your
PERSONAL PROFILE Recent
Passport
Photograph
NAME : _________________________________________________________________________ here

ADDRESS FOR COMMUNICATION:

E-mail Address: ……………………………………………………….. Pin Code: ………………….

Phone No. Office: …………………………… Residence: …………………………

PERMANENT ADDRESS:

Phone No. : Pin Code :…..………………………

Date of Birth : / / Place of Birth : Height : ______Cms.

Marital Status : Blood Group : Weight________ Kgs.
Date Of Marriage : / / PAN Number : _____________________

LANGUAGE PROFICIENCY: Please indicate proficiency level (Good/Average/Poor)

Language Speak Read Write Language Speak Read Write

FAMILY DETAILS: (Including Parents, Dependant Brothers & Sisters)

Sr. Relationship Name Age Highest Occupation
No. Qualification
1 Father
2 Mother
3 Spouse
4 Children
5 Children
6 Sibling
7 Sibling
ACADEMICS / PROFESSIONAL:
Course Period
% Regular/
Examination School / College / (Month &
Specialisation Medium Marks Part
Passed Institution Year)
/CGPA Time
From To
10th / SSC
12th / HSC

Diploma

Graduation

PG Diploma/
PG Degree
ACADEMICS ACHIEVEMENTS:

a. Prizes / Scholarships / Awards won.

b. What factors contributed to your academic achievements?

EMPLOYMENT DETAILS (Please begin with current job)

Duration Period Nature of
Employer’s Name & Location Designation
From To (Yrs & month) Duties
/ / / /
/ / / /
/ / / /
/ / / /
/ / / /
Please draw the relevant part of your Organization Chart to specify the reporting
relationship between you, your superior and subordinates (Two level above & Two level
below your position).
REFERENCES: (Please give three references of your current organisation who can be contacted
or any person other than your relatives)

Sr. Details of References

References
No. Name Designation Contact No. E-Mail Id
Immediate
1
Supervisor
2 Peers
3 Subordinate

4 HR Head
SPECIALISED TRAINING/ON-THE-JOB TRAINING UNDERGONE:
(Please do not mention routine courses)
Duration
Sr. Certificate
Name of the Training Course Institute/Organisation (days/week Year
No. Awarded
/months)
1
2
3

CAREER OBJECTIVES:

a. What made you take up your present subject/area of specialization and what would you
define as your career objective(s)?

b. In what way do you think our Group meets your career objectives?

c. What values do you consider important for professional success?

d. Why do you consider yourself suitable for this position?

MEMBERSHIP OF ANY PROFESSIONAL BODY/ASSOCIATION:

Sr. Type of Membership & Duration of Membership
Name of Institute From To
No. Position Held
1
/ / / /
2
/ / / /
3
/ / / /

LEISURE ACTIVITES:

a. What Leisure time activities do you pursue and how did you develop interest in those?

b. How do these benefit you?

MISCELLANEOUS:
1. Do you have any physical disability: If yes, give details.

2. Have you ever been convicted by a court of Law or is any criminal / civil suit pending
against you in the court?

3. Would you be interested in joining our group even Yes No

If no accommodation is provided?

4. Time required to join in case selected:

5. Any other information that you may like to provide:

(A) ADDITONAL INFORMATION

How did you come to know about this vacant position?

Advertisement Campus Poornata

Others
Reference Consultant
(Specify)
Have you ever applied or been interviewed by any Units of Aditya Birla Group Company? (Yes/No)

Sr. No. Unit Name Position/ JB Department Year/Month

1
2
Have you ever been employed by any Units of Aditya Birla Group Company? (Yes/No)
Relieving
Sr. No. Unit Name Position/ JB Department Joining date
date
1
Do you have any relative working with any Units of Aditya Birla Group Company? (Yes/No)
Sr. No. Name Relationship Unit Name Position/ JB Department

Previous Organization Benefit Account Details (Numbers)

PF Super Annuation ESI

(B) FOR IRS (INTERNAL CANDIDATES ONLY)

Current Job Band : _____________________ Effective from _______________.
Current Designation: ______________________ Effective from _______________.
Are you fully aware about IRS policy (784 & Global Mobility Policy)
Have you ever reported to manager you are about to report after joining this Unit? (Yes/ No)

Have you received an offer from any Aditya Birla Group Company prior to this interview during
last 3-4 years? (Yes/ No)
 REMUNERATION DETAILS WITH PRESENT EMPLOYER, IF ANY
PER MONTH PER ANNUM
DETAILS OF EMOLUMENTS (RS.) (RS.)
- Salary (Basic + DA)
- Conveyance Allowance
- Education Allowance
- LTA
- Medical Allowance
- Special Allowance
- Uniform Allowance
- Any other Allowances : (1)
: (2)
Sub Total ( A ) , , . , , .
- PF Contribution
- Gratuity
- Superannuation
- Bonus / Exgratia
- Any Perf. Linked Incentive
Sub Total ( B ) , , . , , .
- HRA / Accommodation
- Any other City Allowances
Sub Total ( C ) , , . , , .
GRAND TOTAL , , . , , .

Present:
Salary + Monetary Non-Monetary Benefits/
Perquisites (Rs.) Per annum Perquisites

Expected :
Salary + Monetary Non-Monetary Benefits/
Perquisites (Rs.) Per annum Perquisites

The information given by me is true to the best of my knowledge.

Note: - Details declared above shall have to be satisfied with proof on joining.

………….……………
(SIGNATURE)
 RELATIONSHIP DECLARATION

DATE: …………………………………

I ________________________________________________________ hereby solemnly declare that:

(1) Mr. ________________________________________________ who is working as

___________________________ in________________________ Department is related to me as

_________________________ (relationship).

(2) None of the employee (s) of this plant or any other Aditya Birla Group
Companies is related to me.

Declaration
The above information is true to the best of my knowledge and if it is found as false, I shall
be liable for severe disciplinary action by the Company.

Name : Signature:……………………

Date :

Acknowledgement by Candidate
(To be filled on issuing Offer Letter/Letter of Intent)

Offered Job Band: ________

FC w/o Housing: Rs.______________/- per annum

Designation: ____________________

Accommodation: (Family Accommodation/ Bachelor/HRA)

I hereby declare that I have completely understood the CTC structure & accept the above
mentioned compensation details.

Name: Signature

Date: