APPLICATION FOR EMPLOYMENT & PERSONAL INFORMATION FORM
For internal use only: To be filled by HR
Employee ID Number: Please attach recent
Date of Joining :
passport size
Location / HQ. :
photograph
▪ Position applying for ……………………………………………
▪ Please provide complete and correct information in CAPITAL letters.
▪ All fields are MANDATORY.
▪ Please DO NOT use short forms / abbreviations.
▪
Personal Details
Please expand initials of your Name -- Name as per Aadhaar Card
Title (Mr./Ms.) First Name Middle Name Last Name
MR. Akash Sharma
Primary Skill
/
Competency
Gender: Male Female Religion: ………….…………….. Nationality: ……………………….
….. Marital Status: Single MarriedDate of Marriage: No. of Kids:
Date of Birth: Place of Birth:
……………………………... Father’s Name: …………………………………………………...
……………………...….
Mother’s Name: …………………………………............................................................
Contact Number: ……………………………………………………………………………
Emergency Contact Number: ………………………………….……...………………….
Personal Email ID: ……………………………………………..……………………………
Name of Nominee: ……………………...……………….………… Relationship…………………………...…………
Nominee Aadhaar Number: ………………………………………………………………………
: 2:
Current Address : Permanent Address :
Pin Code: Pin Code:
Phone Number : Phone Number :
Current Address Permanent Address
To From To
From (month/year) (month/year) (month/year) (month/year)
Period Of Stay
Your Blood Group ………………..…… Shirt Size ……………………
FAMILY DETAILS:
NAME: GEN.: DOB: RELATION OCCUPATION
M/F DD/MM/YYYY
PAN Card Number: ……………………………………… Aadhaar Card Number: ………………………...…………………………
Driving License Number: ………………………………. Driving License valid up to (mm/dd/yyyy): …....…/…….…/………...
Bank Name: ………………………………………………………………………………………………….
Branch Address: …………………………………………………………………………………………….
Bank A/c No: ……………………………………………………………….………………… IFSC Code: …………….……………………...……………………
: 3:
Reference (From your current employer only)
Name and Designation :
Organization :
Telephone :
Email ID :
Reference (Official / Professional Contact only)
S. No. Name Company Name/Designation Contact No.
Reference
1
Reference
2
Reference
3
Your thoughts on your
suitability for the
position you are
applying for
(max 150 words):
: 4:
Education Details
Period Program % age
Qualification with Specialization / Student ID
Institution Name / University Name (From – To) (Part Time marks /
Specialization Course Name / Reg No.
(dd/mm/yyyy) / Full Time) Division
SSC/ 10th
HSC/ 12th
Diploma
Graduation
Post-Graduation
Others
State Reasons for Gap in Education (if any):
: 5:
Company Name Reported to (Name & Employment Period Last drawn
Sl No (Start from your most Designation HQ Position & direct From - To monthly gross
recent contact number) (dd/mm/ yyyy) salary (INR)
employer)
Employer 1
Employer 2
Employer 3
Employer 4
Employer 5
Your Expected Salary (CTC)…………………………………….
Ensure that you are descriptive wherever necessary – e.g. If your previous company is closed down, please do mention it. Telephone Number with specific
location code, Employee Code/ ID/ Number is mandatory. If your previous employer did not provide the Employee ID, please mention and state reasons for
the same
Employment details should be of the company you are on payrolls of, not of a company you are deputed to on an assignment with. In case you are
showing employments experience in a skill enabling or professional Training institute the same should only be shown if you were on the payrolls of such
an institute.
: 6:
Letter of Authorization
To whom it may concern
If employed by Canixa Life Sciences Pvt. Ltd, I agree to provide copies of mark sheets and
all relevant certificates/ Documents. I understand that employment with Canixa Life
Sciences Pvt. Ltd, is governed by Canixa life Sciences Pvt. Ltd Employment Policies as
applicable, including satisfactory information from a background check.
I hereby certify all of the statements made on the Canixa Life Sciences Pvt. Ltd Employee
Application Form are true and complete and I understand that omission or misrepresentation
of any fact may result in refusal of employment or immediate dismissal.
I hereby authorize Canixa Life Sciences Pvt. Ltd and its representative to verify
information provided in my resume and application of employment, and to conduct enquiries
as may be necessary, at the company's discretion. I authorize all persons who may have
information relevant to this enquiry to disclose it to Canixa Life Sciences Pvt. Ltd. or its
representative. I release all persons from liability on account of such disclosure.
Signature :
Name in Capitals :
Date : / /
For internal use only: To be filled by HR
*Signature of the Recruiter :
Name of the Recruiter :
Date : / /
* The Signature of the recruiter needs to be present in case the application is sent as
soft copy and does not have the signature of the candidate.
* The hardcopy of the email received also needs to be submitted along with this forms
an audit trail.
