DN-32, Sec.
-V, Salt Lake City, Kolkata-700091
Job Application cum Declaration
Paste your
1. Name:______________________________ Nick Name:___________________ recent passport
size photograph
2. Father’s name:___________________
here and sign
3. Permanent Address (With contact numbers):_______________________________________ through
_____________________________________________________________________________
4. Present Address (With Landmark): _______________________________________________
_____________________________________________________________________________
5. Date Of Birth:____________________________________ Age as on date:_______________________
6. Nationality: _____________________________________
7. Voter Card Number: _____________________ Aadhar Card Number: ___________________________
8. PAN Number: ____________________________________
9. Marital Status: ___________________________________
10. Contact No (Residence):__________________ Contact No (Mobile/ Handphone):_________________
11. E-mail address: _______________________________________________________________________
12. Educational Qualification:
Grade/ Percentage
Type of Examination Year of passing Name of Institution/University
Division Obtained
12. Work Experience (if any):
Name of the Organization From To
(Starting with the Present Functional Internal HR
Sr. No Posted at
Employer) (Date) (Date) Role Grade / Band
(Please use separate sheet if required)
13. Have you been referred by any Bandhan employee? Yes No
If Yes, then please share, Employee Name :______________________ Emp. No. : ________ Mobile No. : ____________
14. Have you appeared in any interviews Yes No If Yes, when :____________
in Bandhan earlier?
15. Have you been subjected to any
Disciplinary Proceedings by your previous Yes No
Employer(s) at any time?
If yes, please give a brief description of the case(s) and whether you were punished or exonerated in a separate sheet.
16. Have you ever been proceeded against Yes No
Under any Criminal, Civil statutes?
If yes, please give a brief description of the case(s) and whether you were punished or exonerated in a separate sheet.
17. Do you have any relative working in Bandhan? If yes, please provide the name and the relationship:
1. __________________________________ 2. __________________________________
18. Please submit details of 2 referees acceptable to Bandhan:
1. Name : ____________________________________ 2. Name : ____________________________________
Designation : _______________________________ Designation : _______________________________
Organization: ______________________________ Organization: _______________________________
Office Address: _____________________________ Office Address: _____________________________
__________________________________________ __________________________________________
__________________________________________ __________________________________________
Contact Number: ___________________________ Contact Number: ___________________________
I hereby declare that all statements made hereinabove are true, complete and correct and are not false or misleading.
I understand that in the event of any information so furnished being found false or incorrect or misleading, I may be
dismissed from the services of Bandhan (if selected) or may be proceeded against by Bandhan for giving false and incorrect
statements, under the appropriate law.
NAME : _______________________________ SIGNATURE : ______________________________
DATE : _______________________________ PLACE : _______________________________
For Office Use Only
Verified By:
Name : Code No:
Designation: Division/Cluster:
Comments from Verifier:
