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EMPLOYMENT APPLICATION FORM

POST APPLIED FOR:

Sr. ENGINEER/ASSISTANT MANAGER

FULL NAME IN BLOCK LETTERS


ASHWINI
(LAST)

(FIRST)

PRESENT HOME MAILING ADDRESS:

PLEASE AFFIX
YOUR RECENT
PASSPORT SIZE
PHOTOGRAPH

(MIDDLE)

VPO UGALAN HISSAR THESIL HANSI

HNO 171 DIST HISSAR


TEHSIL HANSI

PIN CODE 125038

TELEPHONE (With Code)

CELL:

9468260464

ashwini sharma71@gmail.com

E-MAIL :

PERMANENT HOME MAILING ADDRESS:

BIRTH DATE

C/O SHRI BHAGWAN

4/12/1993

VPO UGALAN HISSAR THESIL HANSI

AGE (YRS)

VPO UGALAN HISSAR THESIL HANSI

PIN CODE 125038

TELEPHONE (With Code)

PERSONAL DATA

GENDER

CELL:
MARRIAGE DATE

MARITAL STATUS

MALE

(If Married)

CASTE

ST

DT

NT

LANGUAGES KNOWN (Including Foreign)

SBC

ENGLISH
HINDI

9468260464

UGALAN

RELIGION

NATIONALITY

STATE OF DOMICILE

HARYANA

HINDU

INDIAN

HARYANA

OBC

SPEAK

BIRTH PLACE

NATIVE STATE

SINGLE

SC

22

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
235834047799

AADHAR NO.
PAN NUMBER

20282462838(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

USHA RANI

MOTHER

10/9/1977

12TH

HOUSE-WIFE

SHRIBHAGWAN

FATHER

22/10/1974

BROTHER

2/10/1995

AMIT

HEALTH DATA

EMERGENCY CONTACT DETAILS

NAME

ADDRESS

VPO UGALAN HISSAR THESIL HANSI

RELATION

FATHER

MA

WEIGHT (kg)

BLOOD GROUP

182

75

0+

TEACHER

POST GRADUATE
STUDENT

SHRIBHAGWAN

TELEPHONE NO.

HEIGHT (cms)

ORGANIZATION AND POSITION

9416142162

EYESIGHT [SPECIFY POWER IF WEARING GLASSES/LENSES]


Right

PHYSICAL DISABILITY (IF ANY)


NO

Left

CUT MARK ABOVE RIGHT EYE


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,
SCIENCE
ENGLISH,ODI
A

HBSE

FULL TIME

1YR

2009

65

EE

VAISH TECHNICAL
INSTITUTE

HSBTE

FULL TIME

3YR

2012

60

EE

INDUS INSTITUTE OF
ENGG. AND TECH .

KUK

FULL TIME

4YRS

2015

71.2

B.TECH

POST. GRAD. DEGREE /


DIP. CERTIFICATE

DEGREE (S)

DIPLOMA POLYTECH

PRERNA VIDHYA VIHAR


HIGH SCHOOL

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

132 KV SUB STATION

6 WEEKS

2015

JIND SUBSTATION

YES

220 KV SUBSTATION

4 WEEKS

2012

KARNAL SUBSTATION

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

ROLE

TEAM SIZE

DURATION

LANGUAGE / PLATFORM / OS

ELECTRICAL BOAT

AS A BASIC MODEL OF BOAT IN LARGE SEA

2013- 2014

ELECTRICAL BOAT

ELECTRICAL BOAT WITH ALTERNATE


SOLAR TECHNOLOGY

AS A BASIC MODEL OF BOAT IN LARGE SEA

2014- Present

ELECTRICAL BOAT

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

4-Jul-16

Applicant's Signature