US Technology International Private Limited
INSTRUCTIONS:
It is mandatory for you to complete the form in all respects. The information you provide must be complete and correct and the same shall be used for verification of your credentials The details on this form will be used for all official requirements should you join the organization
APPLICATION FOR EMPLOYMENT
US Technology International Private Limited
Applicant No Location Date of Application
Personal Information
Full Name (First, Middle, Last) Former Name / Maiden Name (if Applicable)
Father's Name
Date of Birth (dd/mm/yy)
Gender Male Female Current Address
Personal Identification (PAN No. etc)
Nationality
Marital Status
Period of stay
From (mm/yy)
To (mm/yy) Residence Phone Number
Prominent Landmark
Mobile number
Permanent Address
Period of stay
From (mm/yy)
To (mm/yy) Residence Phone Number
Prominent Landmark
Address History (List most recent first) - Please provide addresses for the last Ten years
Period of Stay From To Address State Country Zip Code Contact Number
Education Qualification - Please attach copy of Degree and Final year mark sheet College Name & Address University Name & Address Dates Attended From To
dd/mm/yy dd/mm/yy
Qualification Gained
ID /Roll No
Full Time Part Time
Employment History (List most recent first and covering last 3 employers) - Current Employer
Note: Ensure that you are descriptive wherever necessary e.g. If Co. is closed, do mention it. Employee Code/ ID/ Number is mandatory. If your previous employer did not provide one, please mention and state reasons for the same. Name of Current Employer Address of Current Employer
Telephone No
Employee Code/No
Designation
Department
From
Employment Period To
Manager's Name
Manager's Contact No Manager's Email ID
Can a reference taken now? Yes No
Duties & Responsibilities
Reasons for leaving
First Salary drawn
Was this Position Agency Details (if temporary or contractual), provide details Permanent Last Salary drawn Temporary Contractual Please tick mark the documents submitted for this employment Service Certificate Relieving letter Offer letter Any Other None (please specify) Previous Employment History (2nd last employer)- Please attach a copy of your relieving letter/service certificate Note: Ensure that you are descriptive wherever necessary e.g. If Co. is closed, do mention it. Employee Code/ ID/ Number is mandatory. If your previous employer did not provide one, please mention and state reasons for the same. Name of Employer Address of Employer
Telephone No
Employee Code/No
Designation
Department
From
Employment Period To
Manager's Name
Manager's Contact No Manager's Email ID
Duties & Responsibilities
Reasons for leaving
First Salary drawn
Was this Position Agency Details (if temporary or contractual), provide details Permanent Last Salary drawn Temporary Contractual Please tick mark the documents submitted for this employment Service Certificate Relieving letter Offer letter Any Other None (please specify)
Previous Employment History (3rd last employer)- Please attach a copy of your relieving letter/service certificate Name of Employer Address of Employer
Telephone No
Employee Code/No
Designation
Department
From
Employment Period To
Manager's Name
Manager's Contact No Manager's Email ID
Duties & Responsibilities
Reasons for leaving
First Salary drawn
Was this Position Agency Details (if temporary or contractual), provide details Permanent Last Salary drawn Temporary Contractual Please tick mark the documents submitted for this employment Service Certificate Relieving letter Offer letter Any Other None (please specify) References: Please provide the details of three professional references Reference (1) Name & Position held:
Address:
Contact Details How do you know this person?
Reference (2) Name & Position held:
Address:
Contact Details How do you know this person?
Please provide details of an Alternate professional reference, in case the above are unavailable. We undertake not to contact your present employer until your consent is gained. Name & Position held: Company Name: Address: Tel. No How do you know this person
Declaration and Authorization
I hereby authorize US Technology International Private Limited (or a third party agent appointed by the Company) to contact any former employers as indicated above and carry out all Background Checks not restricted to education and employment deemed appropriate through this selection procedure. I authorize former employers, agencies, educational institutes etc. to release any information pertaining to my employment/education and I release them from any liability in doing so.
I confirm that the above information is correct to the best of my knowledge and I understand that any misrepresentation of information on this application form may, in the event of my obtaining employment, result in action based on company policy.
Signature:
Name:
Date:
