EMPLOYMENT APPLICATION FORM

POST APPLIED FOR:

Sr. ENGINEER/ASSISTANT MANAGER

FULL NAME IN BLOCK LETTERS

Sharma

Sumit

(LAST)

(FIRST)

PRESENT HOME MAILING ADDRESS:

PLEASE AFFIX
YOUR RECENT
PASSPORT SIZE
PHOTOGRAPH

(MIDDLE)

C/O-SumitSharma

House No 556/11 Krishna Colony,Behind Kundan Cinema

CITY-Jind, Haryana

PIN CODE 126102

TELEPHONE (With Code)

CELL:

9466655686

sharma_sumit88@yahoo.com

E-MAIL :

PERMANENT HOME MAILING ADDRESS:

BIRTH DATE

C/O-SumitSharma

17/07/1988

House No 556/11 Krishna Colony,Behind Kundan Cinema

AGE (YRS)

CITY-Jind, Haryana

PIN CODE 126102

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

9466655686

Jind,Haryana

RELIGION

NATIONALITY

STATE OF DOMICILE

Haryana

HINDU

INDIAN

Haryana

OBC

SPEAK

BIRTH PLACE

NATIVE STATE

SINGLE

SC

28

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
AADHAR NO.

884929787157

PAN NUMBER

CBZPS3939L
50301502640

BANK A/C DETAILS

DETAILS OF FAMILY MEMBERS (parents, spouse, children, siblings & any other dependents excluding self)
NAME

RELATIONSHIP

DATE OF BIRTH

QUALIFICATION

OCCUPATION

ORGANIZATION AND POSITION

NALINI SHARMA

MOTHER

13/09/1962

GRADUATE

TEACHER

O.P.S,SCHOOL,JIND

NARESH KUMAR SHAR NAYAK

FATHER

13/12/1958

GRADUATE

FARMER

MANISHA

SISTER

4/20/1997

GRADUATE
STUDENT

NAYAK

HEALTH DATA

EMERGENCY CONTACT DETAILS

NAME

ADDRESS

OXFORD PUBLIC SCHOOL,JIND

RELATION

MOTHER

NALINI SHARMA

TELEPHONE NO.

HEIGHT (cms)

WEIGHT (kg)

BLOOD GROUP

170

62

B-

01681-247664

EYESIGHT [SPECIFY POWER IF WEARING GLASSES/LENSES]

Right

Left

UNIVERSITY/
BOARD

WHETHER
FULLTIME /
PARTTIME/
CORRES.

DURATION OF
COURSE
(Yrs & Mths)

MONTH &
YEAR OF
PASSING

PHYSICAL DISABILITY (IF ANY)

NO

CUT MARK IN LEFT HAND

IDENTIFICATION MARKS

EDUCATION
EXAMINATION PASSED

SPECIALISATI
ON

SCHOOL / COLLEGE /
INSTITUTION

GRADE %
MARKS

DISTINCTIONS /
SCHOLARSHIPS / PRIZES
WON

SSC OR Equivalent
School leaving Certificate

ALL SUBJECT

CBSE

FULL TIME

1YR

2004

49

H.S.B.T.E

FULL TIME

3YRS

2008

66.86

INDUS
INSTITUTE OF
ENGINEERING & FULL TIME
TECHNOLOGY,KI
NANA

3YRS

2012

70.26

B.TECH

2 YRS

2016

59.99

PURSUING

PRIVATE

POST. GRAD. DEGREE /

DIP. CERTIFICATE

DEGREE (S)

Intermediate or
12th standard / HSC

DIPLOMA

PDMIET,KARSINDHU

E.E

INDUS INSTITUTE OF
ENGINEERING &
TECHNOLOGY,KINANA

MBA HR

NCA,JIND

GJU,HISSAR

CORRES.

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

COLD MINING PROCESS

1 MONTH

2010

JSL,HISSAR

YES

GENERATOR INSTALLATION

1.2 MONTH

2011

ESCORTS,FARIDABAD

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

CRICKET

SKILLS SUMMARY
(Give brief details for the projects you have worked on)
PROJECT TITLE

ROLE

TEAM SIZE

DURATION

POWER GENERATION & STORAGE BY

DANCE FLOOR

Construction and Woking done

2010-11

POWER GENERATION BY LIFT SYSTEM

Construction and Woking done

2011-12

LANGUAGE / PLATFORM / OS

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
JPC,Jind

DURATION
PERIOD(Yrs.)

LAST POSITION HELD DESIGNATION

8 month

Asst. Professor

FROM
22/09/2009

NATURE OF DUTIES

NAME & DESIGNATION OF IMMEDIATE SUPERIOR

Teaching

TO
31/07/2010
GROSS EMOLUMENTS Rs.
Per month

Employee Code

EMPLOYER'S NAME
& ADDRESS

Details of Current
Emoluments
DURATION
PERIOD(Yrs.)
2.2

JIET,Jind

FROM
1/9/2012
TO

Employee Code

11/11/2014
GROSS EMOLUMENTS Rs.
Per month

EMPLOYER'S NAME
& ADDRESS

DURATION
PERIOD(Yrs.)
8 month

JIET,Jind

FROM
22/09/2009
TO

Employee Code

31/07/2010
GROSS EMOLUMENTS Rs.
Per month

EMPLOYER'S NAME
& ADDRESS

DURATION
PERIOD(Yrs.)

NAME-

DESIGNATION-HOD.EE

AT THE TIME OF JOINING

21500

LAST DRAWN

21500

BASIC (P.M.)

FIXED (P.A.)

VARIABLE (P.A.)

GROSS (P.A.)

21500

258000

258000

258000

LAST POSITION HELD DESIGNATION

NATURE OF DUTIES

Lab Technician
NAME & DESIGNATION OF IMMEDIATE SUPERIOR

Maintaining Lab of Computer

NAME- Prof.H.D.Sharma
DESIGNATION-HOD.EE
11500

AT THE TIME OF JOINING

LAST POSITION HELD DESIGNATION

LAST DRAWN

NATURE OF DUTIES

Lab Technician
NAME & DESIGNATION OF IMMEDIATE SUPERIOR

Maintaining Lab of Computer

NAME- Prof.H.D.Sharma
DESIGNATION-HOD.EE
11500

AT THE TIME OF JOINING

LAST POSITION HELD DESIGNATION

LAST DRAWN

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

15600

AT THE TIME OF JOINING

LAST DRAWN

11500

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)
Lab Technician

Asst. Professor

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 TELEPHONIC CALL BY COMPANY HR

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

OR
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

07.04.2016

Applicant's Signature