Novartis Hyderabad
Job Application Form

Name:______________________________________________ 

Position Applied for:_____________________________ 

Novartis is an employer committed to equality of opportunity, fairness, work and lifestyle,

mutual respect and dignity at work for all associates.

This application form is intended only for candidates applying for career opportunities with
Novartis Healthcare Pvt. Ltd., Hyderabad, India.

The information contained herein is required for reasons of compliance with local laws,
statutes and policies, and is completely confidential.

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PERSONAL INFORMATION
Paste your
recent colour
photo
First Name MiddleName Surname

Mr./Ms./Mrs.
Date of Birth (DD/MM/YY) Place of Birth: Sex:

State: Country: Male Female

Place of Work:

Marital Status: Married Single

Father / Spouse Name :

Present Address:

City State Pin Code Mobile

Contact
Numbers Landline

Permanent Address:

City State Pin Code Contact Mobile

Numbers
Landline

E-mail ID:

EDUCATION (Begin with the most recent qualification and end with Std Xth)
Name of the Specialization Name of Location Period Marks
course If any Institute/University From To (% or
CGPA)

Was there any break in your Education? If Yes, give details:

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Scholarships and prizes won during the academic career:

Special Training if any (Project work, Course assignments, Technical training, Professional training etc) :

List any papers published by you:

Membership of recognized professional bodies:

PRESENT EMPLOYMENT DETAILS:

Name of Present Employer / Organization: Address:

Designation: Employee Code: Contact No:

Employment Period: From: To: Notice Period:

Current Role (In brief):

Awards received at work: Are you willing to be posted anywhere?

Yes/No
If no, your preferred location:
Fixed Salary (A): Variable Salary (B): Total Cost to Company
Monthly break up Annual break up Other benefits (Annual)
Basic Variable Pay Provident Fund
(Performance
Linked)
HRA Ex-gratia / Bonus Gratuity

Conveyance LTA Superannuation

Allowance

Special Allowance Medical Medical

Reimbursement Insurance

Any Other Monthly Retention Bonus / Expected Salary

Payment Skill Incentive (if (p.a.)
any)
Total Monthly Total Annual
Salary Salary

Do you have employee stock options? Yes / No If Yes, please mention current value:

Last Performance Review date : Performance Cycle Period :

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LAST EMPLOYMENT DETAILS:
Name & Address Period Employed Designation CTC Details Reasons for
of Employer From / To leaving

Awards received at work:

Was there any break in your service? If yes, give details:

REFERENCES: (please fill at least one of your previous supervisor details as reference)
Reference (1) Reference (2)
Name

Company

Current Designation

Nature of Relationship

Land line (with STD code) /

Mobile:
E-mail ID:
How many years you have known
him/her

ABOUT YOURSELF:

Reason for applying at Novartis:

Have you worked with Novartis earlier? If yes, please mention the details (Designation, period, reasons for
leaving)

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Have you been referred by a Novartis employee? If Yes

Name of Employee Employee Code Line Function

Have you been referred by a Placement Agency? Yes /No If Yes , Name of the placement
agency:

ADDITIONAL DETAILS:

Languages Known:

Nationality: Indian Others Citizenship Status:

Do you hold a valid Yes No If Yes, Passport Number :

Passport?
Valid upto :

Have you attended selection Yes No If Yes, please detail:

Process at Novartis before?

Do you have any relative Yes No If Yes, please detail:

Employed with Novartis?

Have you suffered from any Yes No If Yes, please detail:

Major illness/surgery/
accident in the past five years.
Have you ever been arrested, Yes No If Yes, please detail:
prosecuted or convicted for
any criminal offence?
Any Disability? Yes No

If Yes, please detail:

Do you have any bond/commitment to another employer or organization that might affect your employment with
us?
Yes No If Yes, Please Explain:

DECLARATION
I hereby certify that the facts stated by me in this application are true. I understand that any
misrepresentation or suppression of material information will render me liable to be dismissed by
the Company. I have no objection if you wish to verify my answers.
Name:____________________________

Place:___________________

Date:____________________ Signature of Applicant:_______________

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