HRD/REC/AP
OMNIACTIVE HEALTH TECHNOLOGIES LIMITED
APPLICATION FORM
For Office Use Only Location____________ Dept. ______________ Grade _____________ Sr. No.
PERSONAL PARTICULARS Name (in BLOCK letters)
Surname First Name Middle Name Photograph
Sex
Age
Date of Birth (D/M/Y)
Place of Birth
Marital Status
Religion No. of Children Spouse's Name Father's Name Age (1)
State of Domicile (2) (3) Other dependents Occupation Occupation
Please indicate the type of your present residential accommodation: Own Rented Company's Relatives/Friends Present Residential Address
Paying Guest
Permanent Address
Tel. (Resi.) Mobile
Tel. (Office) E-mail
Tel.
Linguistic Proficiency: (mark your mother tongue, pls. indicate against each language whether fluent, fair or slight) Language Speak Read Write
Membership of Recognised Professional Bodies: Association
HRD/REC/AP
EDUCATION: (begin with the highest qualification) Degree/Diploma or Certificate Name of School, College or University Year of Passing Class & % Principal Subjects Awards
EXPERIENCE: (Begin with present employer) Sr. No. 1. 2. 3. 4. 5. 6. ORGANISATION CHART: Please draw an organisation chart of your dept. mentioning (1) Level above your position; (2) The lower level reporting to you. Name of the Organisation Location From Mth / Yr To Mth / Yr Designation Reporting to No of reportees
HRD/REC/AP PROFESSIONAL TRAINING: Period From To Place of Training Nature of Training
Details of representation in sports at School / College / University:
No. of employees reporting to you
Brief description of your job responsibilities
Last Drawn Salary
Reason for leaving
DETAILS OF CURRENT EMOLUMENTS: Monthly Compensation (A) Particulars Basic HRA Education Conveyance PF (Co. contribution) Others: (1) (2) (3) Total (A x 12) Total Emoluments (A + B + C): Salary expected: If selected, when are you free to start? Others: (1) (2) (3) Rs. LTA Medical Gratuity
Yearly Compensation (B) Rs.
Perks, if any (Yearly) (C)
Particulars
Total
Total
HRD/REC/AP
CAREER PROFILE: What would you consider as your significant contribution to your past and present organisation?
What kind of a career do you visualise for yourself for the next five years?
What would you consider as your strengths?
What would you consider as your weaknesses?
Details of any serious illness you may have suffered from in the past:
Have you applied to this company earlier? Yes / No If yes, post applied for REFERENCES (other than relatives) we shall be writing to each one of them for a reference. No. 1. 2. 3. Name Designation E-mail Contact No.
DECLARATION BY THE APPLICANT: I hereby declare that the information given herein is true to the best of my knowledge and will form the basis of the contract of employment if I am employed by the Company. If at a future date it is found that any of the information furnished herein is untrue or incorrect in any material respect, the Company will have the right to terminate my services without notice or salary in lieu thereof.
Place
Date
Signature
