Employment Application Form
Application Form Please
1. Please provide complete and correct information attach a
2. All fields are mandatory recent
passport
3. Please do not use short forms / abbreviations
size
4. Below details will be used for background verification purposes photograph
Mention your full name as per the Aadhaar Card – As the same would be used in our Employment
records:
Title (Mr./Ms.)
First Name: Middle Name: Last Name:
Complete Current Address: Complete Permanent Address
(Fill the Address which could be verified through a personal visit.
Address: Address proof docs could be any of the valid Govt ID):
Address:
Employment Application
State: Pin: Form
Phone No:
E-mail ID: State: Pin:
Period of stay:
Period of stay:
From: To:
(mm/yy) (mm/yy) From: To:
(mm/yy) (mm/yy)
Father’s Name: Nationality:
Date of Birth:
Notice Period: Total Experience (in Months):
Have you worked with Allstate Before-Yes /No:
If yes, pls mention the duration of employment and Emp id:
1
Personal Details
Government ID Proofs
ID No.
PAN Card (Mandatory)
Passport
Driving License Any one
Voter ID
Education Details
Highest Qualification
Field/ School/University/ From To Part time /
Degree
(Post-Graduation/ Specialization Board (mm/yy) (mm/yy) Full Time
Graduation/ Diploma)
Other Details
Have you been subjected to any court In case you have opted for yes Please specify the
Yes/No
proceedings (civil / criminal) at any time? details
2
Work Experience Details
(Mention NA if you don’t have prior experience)
To HR Contact
From Reason for
Organization Designation (dd/mm/yy Details
(dd/mm/yy) Leaving
) E-mail Id
Signature:
Date:
Place:
3
UNDERTAKING
The company is at liberty to obtain a declaration from the employees that they do not hold any
passport, or the period of passport issued to them has expired and they have not got it renewed.
The PF (Provident Fund) department might have suggested declaration with regard to passport
just to ensure that the company will be in a position to ascertain whether the new employee is an
international worker for EPF (Employee Provident Fund) purpose or is a domestic employee.
I hereby declare that I am an Indian citizen and hold only an Indian passport. I do not hold
any passport issued by authorities from any other country. I also confirm that I had no
passport, or the passport issued to me by (Country) has expired and I have not renewed the
same.
Regards,
(Signature)
Name:
Date:
Letter of Authorization
4
I hereby authorize Allstate India Private Limited (AIPL) either itself or using an, outside agency to verify
and validate the information I have provided including my employment, my personal background, professional
standing, work history and qualifications.
I understand that an outside background agency may obtain information it deems appropriate from various
sources including, but not limited to, the following: current and past employers, criminal conviction records,
school records, college records and professional and personal references.
I authorize, without reservation, any individual, corporation or other private or public entity to AIPL and the
outside background agency all information about me.
I unconditionally release and hold harmless any individual, corporation, or private or public entity from any
and all causes of action that might arise from furnishing to Allstate and the outside agency information that
they may request pursuant to this release.
This authorization and release, in original or photocopied form, shall be valid for this and any future reports
and updates that may be requested.
Signed:
Name in Block Capitals:
Date:
