PRE - APPLICATION FORM
Name: ______________________________________________________________________________________________________
First Name
Middle Name
Last Name
Father's/Husband's Name: ____________________________________________________________________________________
Permanent Address : _________________________________________________________________________________________
_____________________________________________________________________________________________________________
Present Address : ____________________________________________________________________________________________
____________________________________________________________________________________________________________
Mobile No. : _________________________ Alternate No. ______________________ Landline No. _______________________
Date Of Birth : _____________________
Gender : _________________
Marital Status: ____________________No. of Children: __________
Nationality : ___________________ Passport Number: _____________________________________
Date of Issue:____________________________
Date of Expiry:____________________________
Place of Issue:____________________ ECNR Status :_____________________________
Educational Qualification:
S.No.
School/College/Institute
Exams Passed
University/Board
Year of Passing
Professional Qualification:
S.No.
College/Institute
Exams Passed
University
Year of Passing
Experience:
CTC
S.No.
Family Details
S.No.
Name of Org.
Designation
From
Name
Relationship
Age
To
Joining
Occupation
Leaving
Reason For Change
if Dependent (Y/N)
Contact Person In case of emergency:
Name: _________________________________________ Relationship: ______________________ Contact No. ___________________________
Address: _____________________________________________________________________________________________________________
Whether Medically Fit (Yes/No): ____________________
if no, please mention the illness : __________________________________________________________________________________________
Whether Physically fit (Yes/No): ____________________
if no, please mention: ____________________________________________________________________________________________________
Whether involved in any legal / criminal offence (Yes/No) : _____________________________
if yes, please furnish details : _____________________________________________________________________________________________
References, two professional and one personal:
1. Name: ___________________________________________________________ Designation: ______________________________________
Organization: ______________________________________________________ Contact No.: ______________________________________
2. Name: ___________________________________________________________ Designation: ______________________________________
Organization: ______________________________________________________ Contact No.: ______________________________________
3. Name: ___________________________________________________________ Designation: ______________________________________
Organization: ______________________________________________________ Contact No.: ______________________________________
I hereby declare and confirm that the information mentioned in any of the column above is true. I authorize Plintron and its
Authorized representatives to verify information provided in my CV and this form, and to do reference check/conduct enquiries as may be
necessary, at the company's discretion. I authorize all persons who may have information relevant to this enquiry to disclose it to Plintron or its
representative.
I also understand that a false statement or concealment of any information may form ground for my immediate dismissal or my
candidature/employment with Plintron Global Technology Solutions Pvt. Ltd.
Place: ___________________
Date: ____________________
__________________________
Signature
