EMPLOYMENT FORM
APPLICANT No.
Location: Stick 1 Photograph here
Department:
POSITION APPLIED ………………………………………...
FOR:
POSITION
NAME IN FULL
(in block letters)
First Middle Surname
Date of Birth (DD/MM/YYYY) & Age:
SEX: (M/F)______________ Height: Weight:
PERMANENT ADDRESS: Temporary Address:
PERSONAL DETAILS
Mobile No.: 1) 2)
Telephone No.:
e-mail:(Personal)
PLACE OF BIRTH : DOMICILE OF (STATE OF INDIA) :
CITY:
COUNTRY:
CITIZENSHIP(S):
RELATIONSHIP DOB NAME ADDRESS
FATHER
FAMILY DETAILS
MOTHER
SPOUSE
KID - 1
KID - 2
KID - 3
MARITAL STATUS [Single/Married] : Date of Marriage :
ALLERGIES, IF ANY :
BLOOD GROUP :
HEALTH
Vision LAST MAJOR ILLNESS SURGERY:
LEFT: Right: (Specify date)
In order to accommodate employee special needs in the work environment. Please indicate if you are physically challenged(Y/N):
If yes please provide description of disability & accommodation required :
EDUCATIONAL & PROFESSIONAL QUALIFICATIONS (STATE HIGHEST QUALIFICATION FIRST)
(Please complete all fields. Even if you have already provide resume, please provide details on completed degree programs only)
UNIVERSITY / BOARD START END
DEGREE % or Marks MAIN SUBJECTS CGPA*
COLLEGE/INSTITUTE DATE DATE
DOCTORATE
QUALIFICATION
POST
GRADUATION
GRADUATION
Diploma
HSC
SSC
* PAN [Permanent Account Number]: Aadhar:
PLEASE WRITE 'NA' IF NOT APPLICABLE
Specify clearly in case of part time/contract work experience . Notice period required
PERIOD (MM/YYYY)
ORGANISATION WITH
DURATION DESIGNATIO MAJOR RESPONSIBILITIES
LOCATION(Current Org. First) FROM TO
(in months) N
WORK EXPERIENCE
LIST OF TWO PROFESSIONAL REFERENCES :
SR.NO NAME OCCUPATION E-MAIL Mobile No.
DO YOU KNOW ANYONE WORKING AT SERUM INSTITUTE PRESENTLY?(Yes/No):
If yes, Mention the details below.
SR.NO NAME RELATIONSHIP Department & DESIGNATION
1
REFERENCES
DO YOU HAVE ANY RELATIVE WORKING AT SERUM INSTITUTE PRESENTLY?(Yes/No):
If yes, Mention the details below.
SR.NO NAME RELATIONSHIP Department & DESIGNATION
CONTACT PERSON IN CASE OF EMERGENCY :
SR.NO NAME TEL.NO./ MOBILE RELATIONSHIP
2
Organisation Chart
COMPENSATION PM PA
Basic Your immediate Superior
HRA
Dearness Allowance
Conveyance Allowance/
Reimbursement
Professional Journals Your position
Educational Allowance
Other Monthly Allowance
COMPENSATION
SUB TOTAL (A)
2. ANNUAL
LTA
Medical Reimbursement
Bonus/Ex-gratia
Other Annual Benefits
SUB TOTAL (B)
3. RETIREMENT BENEFITS
Provident Fund
Gratuity Subordinates
Superannuation
SUB TOTAL 'C'
GRAND TOTAL (A+B+C)
LOANS : Amount Eligible
BENEFITS
Housing
4 wheeler
Other
SALARY EXPECTED (CTC per annum) :
HAVE YOU APPLIED TO SERUM INSTITUTE PREVIOUSLY?(Yes/No):
IF YES,
WERE YOU CALLED FOR A TEST?
WERE YOU SHORTLISTED FOR AN INTERVIEW?
WERE YOU MADE AN OFFER?
IF ANY OTHER REASON
Have you been employed by Poonawalla Group? (Yes/No):
If Yes, please provide following details :
Tenure (DD/MM/YY)
Business Unit Location Reporting to Employment status Employee No
Start Date End Date
MISCELLANEOUS
ARE YOU EMPLOYED AS :
A. A DIRECTOR IN ANY OTHER COMPANY?(Yes/No):
B. A PARTNER IN ANY FORM?(Yes/No):
IF YES, PLEASE MENTION DETAILS OF THE SAME:
ARE YOU A MEMBER OF ANY POLITICAL PARTY?(Yes/No):
IF YES, PLEASE GIVE DETAILS :
LIST OF THREE OF YOUR MAJOR STRENGTHS AND WEAKNESS
STRENGTHS WEAKNESSES
LIST YOUR MAJOR ACHIEVEMENTS
ARE YOU UNDER ANY LEGAL OBLIGATION TO YOUR CURRENT EMPLOYER?(Yes/No)
IF YES, PLEASE CLARIFY :
MISCELLANEOUS
ANY OTHER INFOMRATION YOU MAY WISH TO PROVIDE IN SUPPORT OF YOUR CANDIDATURE :
Have you at any time been convicted by a court of India for any criminal offence and sentenced to imprisonment, or any criminal proceedings are pending against you
before a court of India, or any order prohibiting your departure from India has been issued by a court? (Yes/No):
If yes, please give details of the same.
NOTICE PERIOD FOR JOINING :
I certify that the above information given by me in this Employement Form is true, complete and correct.
All the Acadamic Marks/ Percentage/ CGPA are correct. Also the salary structure and all other information provided in this form
is correct and updated.I agree that in case the company finds any time during my employement that the information given by me
in this Employement form is incorrect, false or incomplete, the company will have the right to withdraw my letter of appointment
or terminate my appoitment at any time without any notice or compensation.
I Authorise company to verify information given in this form at any time during my employement by any external agency
to refference check with my past Employer, college , school, without my consent.
Place : Signature of Candidature
Date :
Candidature Name
FOR OFFICIAL USE ONLY
VACANCY NO.: Requisition By Source :
NEW/ REPLACEMENT Replacement of : Employee Status : Trainee / Probation
