EMPLOYMENT APPLICATION FORM

POST APPLIED FOR:

Sr. ENGINEER/ASSISTANT MANAGER

FULL NAME IN BLOCK LETTERS

KULDEEP
(FIRST)

(MIDDLE)

PRESENT HOME MAILING ADDRESS:

PLEASE AFFIX
YOUR RECENT
PASSPORT SIZE
PHOTOGRAPH

(LAST)

C/O- RAMMEHAR

H.NO. 2866A, HOUSING BOARD (NEAR PUNIA HOSPITAL)

CITY- JIND (HARYANA)

PIN CODE

TELEPHONE (With Code)

CELL:

126102
9467011838

kuldeepgautam1993@gmail.com

E-MAIL :

PERMANENT HOME MAILING ADDRESS:

BIRTH DATE

C/O-RAMMEHAR

14/04/1993

H.NO. 2866A, HOUSING BOARD (NEAR PUNIA HOSPITAL)

AGE (YRS)

CITY-JIND(HARYANA)

PIN CODE

TELEPHONE (With Code)

PERSONAL DATA

GENDER

CELL:
MARRIAGE DATE

MARITAL STATUS

MALE

(If Married)

CASTE

ST

DT

NT

SBC

LANGUAGES KNOWN (Including Foreign)

ENGLISH
HINDI

BIRTH PLACE

9467011838

JIND (HARYANA)

RELIGION

NATIONALITY

STATE OF DOMICILE

HARYANA

HINDU

INDIAN

HARYANA

OBC
SPEAK

126102

NATIVE STATE

SINGLE

SC

22

GEN.CAT

READ

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

WRITE

ODIA

PASSPORT NO.
PASSPORT ISSUE DATE
VALID UPTO DATE
COUNTRY OF ISSUE
489588095944

AADHAR NO.
PAN NUMBER
BANK A/C DETAILS
DETAILS OF FAMILY MEMBERS (parents, spouse, children, siblings & any other dependents excluding self)
NAME

RELATIONSHIP

DATE OF BIRTH

QUALIFICATION

OCCUPATION

SUSHEELA

MOTHER

26/071978

ILLITRATE

HOUSE-WIFE

RAMMEHAR

FATHER

25/02/1967

12TH

RENU

SISTER

4/8/1998

12TH

POONAM

SISTER

14/04/1995

HEALTH DATA

EMERGENCY CONTACT DETAILS

NAME

ADDRESS

H.NO. 2866A, HOUSING BOARD (NEAR PUNIA HOSPITAL)

RELATION

FATHER
WEIGHT (kg)

BLOOD GROUP

165

74

O+

TOURISM
DEPARTME
NT

POST-

GRADUATE
STUDENT

RAMMEHAR

TELEPHONE NO.

HEIGHT (cms)

GOVT. JOB

ORGANIZATION AND POSITION

8901577674

EYESIGHT [SPECIFY POWER IF WEARING GLASSES/LENSES]

Right

PHYSICAL DISABILITY (IF ANY)

NO

Left

MOLE ON UPPER LIP IN LEFT SIDE

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

MOTI LAL NEHRU PUBLIC SCHOOL

NON MEDICAL

MOTI LAL NEHRU PUBLIC SCHOOL

ELECTRICAL

INDUS INSTITUTE OF ENGG. &

TECHNOLOGY

CENTRAL
BOARD OF
SECONDARY
EDUCATION
CENTRAL
BOARD OF
SECONDARY
EDUCATION

KURUKSHETRA
UNIVERSITY

FULL TIME

1YR

2009

75%

FULL TIME

2YRS

2011

72%

FULL TIME

4YRS

2015

74%

B.TECH

POST. GRAD. DEGREE /

DIP. CERTIFICATE

DEGREE (S)

Intermediate or
12th standard / HSC

MATH,
SCIENCE
ENGLISH,HIN
DI, SOCIAL
STUDIES

MEMBERSHIP OF PROFESSIONAL INSTITUTE

NAME OF INSTITUTE

TYPE OF MEMBERSHIP AND POSITION HELD

TRAINING / CERTIFICATIONS
NAME OF THE TRAINING COURSE

DURATION

TRANSMISSION AND DISTRIBUTION

1 MONTH

PAP
ERS SWITCHYA
EXT
1 MONTH
RD
PUB
RA
LISH
CUR
ED /
RIC
In
PRE
ULA
unbr
SEN
TITLE
R
oken
TED
ACTI
chro
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nolo
(E.G
gical
.orde
Spor
r
start
ts,
ing
Soci
ACTIVITY
from
al &
your
Lite
pres
rary
ent
acti
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SKILLS
SUMMARY
vitie
oym
sent
(Give brief details for the projects you have worked on)
etc.
and
PROJECT TITLE
ROLE
endi
)
ng
with
WO
first
RK
empl
oym
EXP
ent
ERI
(Plea
EN
se
acco
CE
unt
for
all EMPLOYER'S NAME
& ADDRESS
the
perio
ds of
time
not
cove
red
by
educ
ation

DURATION
PERIOD(Yrs.)

NA
ME
&
DA
TE
OF
TH
E
SE
MI
NA
R
/
JO
UR
NA
L
IN
W
HI
CH
PR
ES
EN
TE
D
/
PU
BLI
SH
ED

PERIOD

DURATION OF MEMBERSHIP
FROM

YEAR

INSTITUTE / ORGANISATION

WHETHER CERTIFICATE
AWARDED

2013

HMT MACHINE TOOLS PRIVATE LTD.

YES

2014

PANIPAT THERMAL POWER PLANT

YES

YEAR

TEAM SIZE

LAST POSITION HELD

DESIGNATION

POSITION HELD

DURATION

NATURE OF DUTIES

PRIZES WON

LANGUAGE / PLATFORM / OS

FROM

NAME & DESIGNATION OF

IMMEDIATE SUPERIOR

TO
GROSS EMOLUMENTS Rs.
Per month

Employee Code

EMPLOYER'S NAME
& ADDRESS

Details of Current
Emoluments

DURATION
PERIOD(Yrs.)

AT THE TIME OF JOINING

LAST DRAWN

BASIC (P.M.)

FIXED (P.A.)

LAST POSITION HELD

DESIGNATION

VARIABLE (P.A.)

NATURE OF DUTIES

FROM
NAME & DESIGNATION OF
IMMEDIATE SUPERIOR
TO
Employee Code
GROSS EMOLUMENTS Rs.
EMPLOYER'S NAME
& ADDRESS

Per month

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.
EMPLOYER'S NAME
& ADDRESS

Per month

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.
DRA EMPLOYER'S NAME
W IN
& ADDRESS
BRIEF
THE
ORGA
NISAT
ION
STRU
CTUR
E OF
THE
COMP Employee Code
ANY
WHEEMPLOYER'S NAME
RE
& ADDRESS
YOU
ARE
PRES
ENTL
Y
EMPL
OYED
INDIC
ATIN
Employee Code
G
TWO
LEVE
LS
ABOV
E
AND
ONE
LEVE

Per month

DURATION
PERIOD(Yrs.)

AT THE TIME OF JOINING

LAST DRAWN

LAST POSITION HELD

DESIGNATION

NATURE OF DUTIES

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

DURATION
PERIOD(Yrs.)

AT THE TIME OF JOINING

LAST DRAWN

LAST POSITION HELD

DESIGNATION

NATURE OF DUTIES

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

AT THE TIME OF JOINING

LAST DRAWN

GROSS (P.A.)

CONS
TRUC
WHAT ARE YOUR SIGNIFICANT ACHIEVEMENTS AND EXPLAIN WHY YOU CONSIDER YOURSELF SUITED FOR THE POSITION :
TION
MANA
GER

ASSIS
TANT
CONS
TUCT
ION
MANA
GER

SENIO
R
ENGI
NEER(
MY
POSIT
ION)
ENGI
NEER
10
NUMB
ERS
OF
PERS
ONS
WOR
KING
UNDE
R ME

GENERAL DATA

HAVE YOU
Succe
EVER
ssful
BEEN
comp
INTERVIE
letion
WED BY
of
SHYAM
the
INDUS
Lafar
POWER
ge
SOLUTION
Railw
S PVT.
DATE/YEAR
YES
NO
ay
LTD.?
siding
proje

ct in
a
best
If Yes, give
econ
details
omiz
ed
mann
er to
the
comp
any.IN SHYAM INDUS POWER SOLUTIONS PVT. LTD.
NTANCE
NAME
NA
HOW DID
YOU
ARE YOU
COME
TO
ENGAGED
KNOW OF
INTHIS
ANY
DO YOU
PERSONAL
POSITION?
HAVE
ANY
BUSINESS
CONTRAC
? YES
T / BOND
NAME,
WITH
ADD.,
YOUR
ANDIFTELYES
PRESENT
Nos. OF
EMPLOYE
SELECTED
R?
, TWO
WHEN
SUPERIOR
CAN YOU
S
JOIN?
FAMILIAR
HAVE
WITH
YOU EVER
YOUR
BEEN
WORK
INVOLVED
(NOT
IN ANY
RELATIVE
CRIMINAL
S)
PROCEEDI
NGS /
CONVICTE
D OF ANY
OFFENCE?
IF YES,
GIVE
DETAILS

I
NO
decla
re
that
the
NO
infor
matio
n
Igiven
hereb
above
yis
decla
true
COMPANY &
NAME
re
DECL
to
POSITION
that
ARATII
the
am
ON
best
not
UNDE
of
conn
R
my
ected
SECTI
knowl
with
ON
edge.
314
Iany
am
ofOF
awar
the
eCOMP

Direc
ANIES
that
Estab
tors
ACT,
any
lishin
of
AS
false
g
a
the
AMEN
or
railw
Comp
DED
incorr
ay
any
IN
ect
depot
as
his
1974
infor
OR
with
partn
(Tick
matio
const
er
or
n
by
Iwhich
hereby
declare that I am a partner or relative of
itutin
his
ever
me
g
relati
is
may
as
Railw
ve
as
appli
result
ay
defin
cable
in
sleep
ed
)
termi
er
under
natio
produ
secti
n of
ction,
on
JIND
my 6 PLACE
Rail
of
servic
panel
the
e
weldi
Comp
with
ng
anies
the
and
Act
Comp
all
1956I
any.
other
have
railw
no
ay
objec
relat
tion
ed
to
works
your
in
inquir
West
ing
ern
from
Dedic
any
ated
of my
previ
ous
Freig
empl
ht
oyers
Corri
on
dor
any
Proje
matt
ct
CRIMINAL
RECORD

PO
SIT
IO
N

RELATIONSHIP

COMPANY

BY
TE
if
LE
YE
PH
S,
ON
in
IC
dic
CA
at
LL
e
BY
na
CO
if
tur
MP
YE
e
AN
S,
of
Y
Gi
bu
HR
ve
sin
De
ess
tai
ls

POSITION

COMPANY & TELEPHONE NOS.

TELEPHONE NOS.

a Director of the Company

.

DATE

08.04.2016

Applicant's
Signature

E-MAIL ID

SE AFFIX
RECENT
PORT SIZE
TOGRAPH

H DATE

04/1993
22

H PLACE

HARYANA)

TATE OF DOMICILE
HARYANA

ce Caste Certificate]

88095944

ON AND POSITION

STOREKEEPER

SABILITY (IF ANY)

DISTINCTIONS /
OLARSHIPS / PRIZES
WON

B.TECH

ERSHIP
TO

R CERTIFICATE
WARDED

YES

YES

PRIZES WON

PLATFORM / OS

GROSS (P.A.)

MPANY

MAIL ID

10