APPLICATION FORM
Please fill in the details with utmost attention, as these shall be verified by RFPIO And / or by its authorized
representatives.
All details are compulsory. Please Affix Your
Passport Size
Photograph
PERSONAL DETAILS
Name of Applicant: Surname: Lawrence Middle: Antony First: Praveen
Date of Birth (dd/mm/yy): 18-06-1983 Place of Birth: Coonoor
Sex: Male Nationality: Indian
Father’s Name: A. Lawrence Passport No.: H8067729
Home Phone: 9047027718 Office Phone: Mobile: 9626971081
RESIDENTIAL ADDRESSES
PERMANENT ADDRESS:
166 SAMAYAPURAM ALWARPET
COONOOR – 643101
THE NILIGIRIS.
City: Coonoor State: Tamilnadu
Pin: 643101 Phone No.: 9626971081
Duration of Stay: From (1983) To (Present)
Nature of location: Rented Own Other (Specify)
CURRENT ADDRESS:
27 Dhamodhara Swamy Layout,
N.K Palayam
Coimbatore - 641033
City: Coimbatore State: Tamilnadu
Pin: 641033 Phone No.: 9626971081
Duration of Stay: From (10/2015) To (10/2020)
Nature of location: Rented Own Other (Specify)
All fields are mandatory Strictly Private & Confidential
EDUCATION DETAILS
DATES ROLL
NAME & ATTEN NUM
ADD COURSE DED BER/
RESS ATT REGI
NAME & ADDRESS OF
OF END MARKS (%) STRA
BOARD / UNIVERSITY
SCH ED CG TION
TO WHICH THE SCHOOL / (MORNING/
QUALIFICATION OOL / PA NUM
COLLEGE / EVENI
COL NG/ & YEAR YEAR BER/
INSTITUTE
LEGE CORR CLASS EXA
IS AFFILIATED TO ESPON
/ DENC
M
INSTI E) SEAT
TUTE NUM
BER
GRADUATION VL
Balak
rishn
a
Janak B.B.M
DEGREE: iamm
al Bharathiar University 60% 2001 2004 0123F0712
Colle
DISCIPLINE: ge of
Arts
&
Scien
ce
POST
GRADUATION
DEGREE:
DISCIPLINE:
ANY OTHER
REASONS FOR BREAKS IN EDUCATION:
______________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
All fields are mandatory Strictly Private & Confidential
EMPLOYMENT RECORD: Starting with your most recent employer, please list last 3 employments. When listing consulting or temporary
assignments, under “Employer”, state the name of the consulting or temporary agency that placed you at the client site. Complete and accurate
dates (month/year) must be provided.
EMPLOYER 1: Agogzen Infotech Employee Id: From (06/2008): To (02/2010):
Street Address: 837/5 SENTHOOR NAGAR KARUPPARAYAMPALAYM Employer’s Fax No.:
MAIN ROAD, Phone No.: 99860
97222
City: Coimbatore State: Tamilnadu Country: India Postal Code: 641014
Job Title: Operations Manager Reason for Leaving: Got Better Opportunity
Employment Status: (Please check the relevant box) Supervisor’s Details:
Name: Joseph Rozario
Full Time
Contract /Through Outsourcing Agency Title: Manager
Phone No.: 99943 27744
Outsourcing Agency Details: E-mail id: josephrozario.a@gmail.com
Name: (Preferably official)
Address: HR Manager’s Details:
Tel No.: Name: Savithiri Iyer
Description of Duties: client handling & Phone No.: 99860 97222
responsible for all administration regards E-mail id: jose.savithri@in.bosch.com
to operations (Preferably official)
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EMPLOYER 2: Pathfinder Business Analysis Pvt Employee Id: 0565 From (03/2010): To (08/2017):
Ltd
Street Address: #18 R.R.Industrial Estate, Singanallur Employer’s Fax No.:
Phone No.: 0422
220 3300
City: Coimbatore State: Tamilnadu Country: India Postal Code: 641005
Job Title: Assistant Manager Reason for Leaving: Got better opportunity
Employment Status: (Please check the relevant box) Supervisor’s Details:
Name: Anand Jesudass
Full Time
Contract /Through Outsourcing Agency Title: Managing Director
Phone No.: 90470 77707
Outsourcing Agency Details: E-mail id: anand@pathfinderanalysis.com
Name: (Preferably official)
Address: HR Manager’s Details:
Tel No.: Name: Murali
Description of Duties: handle property tax clients Phone No.: 90470 77703
& ensure evaluation is performed for each E-mail id:
team member (Preferably official) Murali@pathfinderanalysis.com
EMPLOYMENT RECORD CONTINUED :
EMPLOYER 3: PARK Group of Companies Employee Id: From (09/2017): To (05/2019):
Street Address: 498/1-B, Dr.Jagannatha Nagar, Opp. to CMC Signal, Employer’s Fax No.:
Phone No.: 0422
661 0600
City: Coimbatore State: Tamilnadu Country: India Postal Code: 641014
Job Title: Assistant Manager Reason for Leaving: Got Better Opportunity
Employment Status: (Please check the relevant box) Supervisor’s Details:
Name: Muralidharan
Full Time
Contract /Through Outsourcing Agency Title: Vice President
Phone No.: 90470 77703
Outsourcing Agency Details: E-mail id:
Name: (Preferably official) Murali@parkgroup.com
Address: HR Manager’s Details:
Tel No.: Name: Saravana Murali
Description of Duties: responsible for digital Phone No.: 9047007363
marketing deliverables & other client E-mail id: saravanamurali@parkgroup.com
related activities. (Preferably official)
REASONS FOR BREAKS IN EMPLOYMENT HISTORY: ______________________________________________
All fields are mandatory Strictly Private & Confidential
____________________________________________________________________________________________
PROFESSIONAL REFERENCES:
PARTICULARS REFERENCE 1 REFERENCE 2 REFERENCE 3
Anand Jesudass Murali Savithiri Iyer
NAME
Pathfinder Park Group Of Bosch
Organization Companies
Managing Director Vice President HR Head
Designation/Position
0422 -2203300 0422 - 661 0600
Landline No. 99860 97222
9047077707 9047077703
Mobile No. 99860 97222
anand@parkgroup.co murali@parkgroup.com jose.savithri@in.bosch.com
Email Address m
INFORMATION RELEASE AUTHORIZATION
I certify that the statements made in this application are valid and complete to the best of my knowledge. I understand that false or
misleading information may disqualify me from employment and /or result in termination of employment.
I understand that RFPIO may request a verification of information provided by me and /or background check from an agency hired by
RFPIO for this purpose.
I further understand that the results of verification and checks and any records made out of that information will be used for employment
purposes only and will not be given to unauthorized persons.
I authorize RFPIO and/or its agents Pinkerton Corporate Risk Management India Pvt Ltd. to conduct a verification and background check
including but not limited to the verification and check of information and references stated by me in this application for the consideration
of RFPIO.be used only for my employment purposes.
I also authorize all the concerned persons, authorities, organizations, their employees, agents or authorized representatives, whether named
in the application or not, to release the information in their knowledge / possession / records relevant to my employment.
In the event that RFPIO and /or its agents are unable to verify any information and references stated in this application, it is my
responsibility to furnish the necessary documentation in support of that information.
I fully understand that this application or subsequent employment does not create a contract of employment nor guarantee employment for
any definite period of time and my employment decision will always be at the sole discretion of RFPIO.
I have read, understood, and by my signature consent to these statements.
I authorize RFPIO. to contact my present employer. Yes No
All fields are mandatory Strictly Private & Confidential
SIGNATURE:
DATE: 01-10-2019
NAME (IN BLOCK LETTERS): PRAVEEN ANTONY. L
All fields are mandatory Strictly Private & Confidential
