EMPLOYMENT APPLICATION FORM

POST APPLIED FOR:

Sr. ENGINEER/ASSISTANT MANAGER

FULL NAME IN BLOCK LETTERS

SANDEEP
(LAST)

(FIRST)

PRESENT HOME MAILING ADDRESS:

PLEASE AFFIX
YOUR RECENT
PASSPORT SIZE
PHOTOGRAPH

(MIDDLE)

H. NO. 525/1, JOGINDER NAGAR

OPP NEW POWER HOUSE

JIND

PIN CODE 126102

TELEPHONE (With Code)

CELL:

9034093209

sandeep.singhroha209@gmail.com

E-MAIL :

PERMANENT HOME MAILING ADDRESS:

BIRTH DATE

H.NO. 525/1, JOGINDER NAGAR

14/01/1989

OPP. NEW POWER HOUSE

AGE (YRS)

JIND

PIN CODE 126102

TELEPHONE (With Code)

PERSONAL DATA

GENDER

CELL:
MARRIAGE DATE

MARITAL STATUS

MALE

(If Married)

MARRIED

SC

CASTE

DT

NT

LANGUAGES KNOWN (Including Foreign)

SBC

ENGLISH
HINDI

9034093209

JIND

RELIGION

NATIONALITY

STATE OF DOMICILE

HARYANA

HINDU

INDIAN

HARYANA

OBC

SPEAK

BIRTH PLACE

NATIVE STATE

2/9/2012

ST

27

GEN.CAT
READ

[Other than GEN.CAT please arrange to produce Caste Certificate]

WRITE

PASSPORT NO.
PASSPORT ISSUE DATE
VALID UPTO DATE

ODIA

COUNTRY OF ISSUE

689469521801

AADHAR NO.
PAN NUMBER

20290669547(SBI)

BANK A/C DETAILS

DETAILS OF FAMILY MEMBERS (parents, spouse, children, siblings & any other dependents excluding self)
NAME

RELATIONSHIP

DATE OF BIRTH

QUALIFICATION

OCCUPATION

INDRAWATI

MOTHER

10/9/1962

NIL

HOUSE-WIFE

PHOOL CHAND

FATHER

5/4/1957

BROTHER

8/5/1985

SATISH

HEALTH DATA

EMERGENCY CONTACT DETAILS

NAME

ADDRESS

H. NO. 525/1, JOGINDER NAGAR

RELATION

FATHER

B.A
POST GRADUATE

WEIGHT (kg)

BLOOD GROUP

182

69

0+

GOVT. EMP.
EMPLOYEE

PHOOL CHAND

TELEPHONE NO.

HEIGHT (cms)

ORGANIZATION AND POSITION

9466891085

EYESIGHT [SPECIFY POWER IF WEARING GLASSES/LENSES]

Right

PHYSICAL DISABILITY (IF ANY)

NO

Left

MINOR CUTMARK ON LEFT LEG

IDENTIFICATION MARKS

EDUCATION
EXAMINATION PASSED

SPECIALISATI
ON

SCHOOL / COLLEGE /
INSTITUTION

UNIVERSITY/
BOARD

WHETHER
FULLTIME /
PARTTIME/
CORRES.

DURATION OF
COURSE
(Yrs & Mths)

MONTH &
YEAR OF
PASSING

GRADE %
MARKS

DISTINCTIONS /
SCHOLARSHIPS / PRIZES
WON

SSC OR Equivalent
School leaving Certificate

MATH,
SCI.,ENG,HIN SAINT VIVEKANAND HIGH
DI,SS,MUSIC
SCHOOL

HBSE

FULL TIME

1YR

2005

64

COMPUTER
ENGG

PDM INSTITUTE OF ENGG

AND TECHNOLOGY,
KINANA

HSBTE

FULL TIME

3YR

2009

69.3

ELECTRICAL
ENGG

INDUS INSTITUTE OF
ENGG. AND TECH .

KUK

FULL TIME

4YRS

2012

72

B.TECH

POST. GRAD. DEGREE /

DIP. CERTIFICATE

DEGREE (S)

DIPLOMA POLYTECH

MEMBERSHIP OF PROFESSIONAL INSTITUTE

NAME OF INSTITUTE

TYPE OF MEMBERSHIP AND POSITION HELD

PERIOD

DURATION OF MEMBERSHIP
FROM

TO

TRAINING / CERTIFICATIONS
NAME OF THE TRAINING COURSE

DURATION

YEAR

INSTITUTE / ORGANISATION

WHETHER CERTIFICATE
AWARDED

MAINTANCE

6 WEEKS

2010

THE JIND CO.OPERATIVE SUGAR MILLS JIND

YES

MAINTANCE

4 WEEKS

2012

VITA MILK PLANT JIND

YES

PAPERS PUBLISHED / PRESENTED

TITLE

NAME & DATE OF THE SEMINAR / JOURNAL IN WHICH PRESENTED / PUBLISHED

EXTRA CURRICULAR ACTIVITY (E.G. Sports, Social & Literary activities etc.)
ACTIVITY

INSTITUTION/ASSOCIATION/SOCIETY/CLUB

YEAR

POSITION HELD

PRIZES WON

SKILLS SUMMARY
(Give brief details for the projects you have worked on)
PROJECT TITLE

AUTOMATIC VOLTAGE STABLIZER

ROLE
CAN PROVIDE AUTOMATIC VOLATGE REGULATION
IN CIRCUIT

ELECTRICITY PRODUCED BY WIND ENERGY ELECTRICITY GENERATION BY WIND ENERGY

TEAM SIZE

DURATION

LANGUAGE / PLATFORM / OS

2011

AUTOMATIC VOLTAGE STABLIZER

2012

ELECTRICITY PRODUCED BY WIND

ENERGY

WORK EXPERIENCE
In unbroken chronological order starting from your present employment and ending with first employment
(Please account for all the periods of time not covered by education / training) [Please attach extra sheet if required]
EMPLOYER'S NAME
& ADDRESS

DURATION
PERIOD(Yrs.)

LAST POSITION HELD DESIGNATION

NATURE OF DUTIES

SENIOR ENGINEER

TO

GROSS EMOLUMENTS Rs.

Per month

Employee Code

EMPLOYER'S NAME
& ADDRESS

Details of Current
Emoluments
DURATION
PERIOD(Yrs.)

AT THE TIME OF JOINING

BASIC (P.M.)

FIXED (P.A.)

LAST POSITION HELD DESIGNATION

VARIABLE (P.A.)

GROSS (P.A.)

NATURE OF DUTIES

FROM
NAME & DESIGNATION OF IMMEDIATE SUPERIOR
TO
Employee Code
GROSS EMOLUMENTS Rs.
Per month

EMPLOYER'S NAME
& ADDRESS

DURATION
PERIOD(Yrs.)

AT THE TIME OF JOINING

LAST DRAWN

LAST POSITION HELD DESIGNATION

NATURE OF DUTIES

FROM
NAME & DESIGNATION OF IMMEDIATE SUPERIOR
TO
Employee Code
GROSS EMOLUMENTS Rs.
Per month

EMPLOYER'S NAME
& ADDRESS

DURATION
PERIOD(Yrs.)

AT THE TIME OF JOINING

LAST DRAWN

LAST POSITION HELD DESIGNATION

NATURE OF DUTIES

FROM
NAME & DESIGNATION OF IMMEDIATE SUPERIOR
TO
Employee Code
GROSS EMOLUMENTS Rs.
Per month

EMPLOYER'S NAME
& ADDRESS

DURATION
PERIOD(Yrs.)

AT THE TIME OF JOINING

LAST DRAWN

LAST POSITION HELD DESIGNATION

NATURE OF DUTIES

FROM
NAME & DESIGNATION OF IMMEDIATE SUPERIOR
TO
Employee Code
GROSS EMOLUMENTS Rs.
Per month

EMPLOYER'S NAME
& ADDRESS

DURATION
PERIOD(Yrs.)

AT THE TIME OF JOINING

LAST DRAWN

LAST POSITION HELD DESIGNATION

NATURE OF DUTIES

FROM
NAME & DESIGNATION OF IMMEDIATE SUPERIOR
TO
Employee Code
GROSS EMOLUMENTS Rs.
Per month

AT THE TIME OF JOINING

LAST DRAWN

DRAW IN BRIEF THE ORGANISATION STRUCTURE OF THE COMPANY WHERE YOU ARE PRESENTLY EMPLOYED INDICATING TWO
LEVELS ABOVE AND ONE LEVEL BELOW YOUR POSITION (PLEASE ALSO INDICATE THE TOTAL NUMBER OF PERSONS UNDER YOU)

WHAT ARE YOUR SIGNIFICANT ACHIEVEMENTS AND EXPLAIN WHY YOU CONSIDER YOURSELF SUITED FOR THE POSITION :

HAVE YOU EVER BEEN INTERVIEWED BY SHYAM INDUS POWER SOLUTIONS PVT. LTD.?

YES

NO

DATE/YEAR

POSITION

COMPANY

If Yes, give
details

RELATIVES / ACQUAINTANCE IN SHYAM INDUS POWER SOLUTIONS PVT. LTD.

NAME

RELATIONSHIP

POSITION

COMPANY & TELEPHONE NOS.

GENERAL DATA

NA

HOW DID YOU COME TO KNOW OF THIS POSITION?

BY CAMPUS OF IIET

ARE YOU ENGAGED IN ANY PERSONAL BUSINESS ?

YES

NO

DO YOU HAVE ANY CONTRACT / BOND

WITH YOUR PRESENT EMPLOYER?
YES

NO

if YES,
indicate nature of
business
if YES,
Give Details

IF SELECTED, WHEN CAN YOU JOIN?

NAME, ADD., AND TEL Nos. OF TWO SUPERIORS FAMILIAR WITH YOUR WORK (NOT RELATIVES)

CRIMINAL
RECORD

NAME

COMPANY & POSITION

TELEPHONE NOS.

E-MAIL ID

HAVE YOU EVER BEEN INVOLVED IN ANY CRIMINAL PROCEEDINGS / CONVICTED OF ANY OFFENCE? IF YES, GIVE DETAILS

DECLARATION UNDER SECTION 314 OF COMPANIES ACT, AS AMENDED IN 1974 (Tick whichever is applicable)
I hereby declare that I am not connected with any of the Directors of the Company as his partner or his relative as defined under section 6 of the
Companies Act 1956
I hereby declare that I am a partner or relative of

a Director of the Company

as

I declare that the information given above is true to the best of my knowledge. I am aware that any false or incorrect information by me may result in termination of
my service with the Company. I have no objection to your inquiring from any of my previous employers on any matters pertaining to me, if I join your Company.
PLACE

JIND

DATE

7-Apr-16

Applicant's Signature