0% found this document useful (0 votes)
88 views4 pages

Joining Application Form

This document contains an application form for Archem Healthcare. The form requests personal details such as name, date of birth, gender, marital status, family background, religion, present and permanent addresses, email, and passport information. It also asks for academic details including degrees/diplomas obtained from different institutes, languages spoken and proficiency levels. Work experience details including total years, companies worked for, designations, dates, salaries are also solicited. The applicant is asked to provide their current job profile, reporting structure and two references. The applicant needs to declare that all information provided is true.

Uploaded by

Jasveer Kaur
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
0% found this document useful (0 votes)
88 views4 pages

Joining Application Form

This document contains an application form for Archem Healthcare. The form requests personal details such as name, date of birth, gender, marital status, family background, religion, present and permanent addresses, email, and passport information. It also asks for academic details including degrees/diplomas obtained from different institutes, languages spoken and proficiency levels. Work experience details including total years, companies worked for, designations, dates, salaries are also solicited. The applicant is asked to provide their current job profile, reporting structure and two references. The applicant needs to declare that all information provided is true.

Uploaded by

Jasveer Kaur
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
You are on page 1/ 4

Archem Healthcare

REF. NO

Application Form

Kindly paste your


recent Passport
Size Photograph

Full Name
(In Block Letters)

_______________
First Name

________________

________________

Middle Name

Surname

(To be Filled by HR Department Only)


Interview for the Post of: ____________________________________
Source of Application: (Databank / Advt / Ref.) _________________
Division: __________________ Department: ____________________
Location: (HO / Factory / Field)________________________

PERSONAL DETAILS
1. Date of Birth:
(DD)
2. Age:

(MM)

(YEAR)

_____ Years ______ Months

3. Gender:

Male

Female

4. Marital Status:

Single

Married

Divorced

5. Family Background:
Relationship

Age

Profession /
Occupation

Qualification

Income
(p.a.)

Remarks

Father
Mother
Husband / Wife
Brother / Sister
Brother / Sister
Child 1
Child 2
6. Religion: ___________________

Caste: ____________________

7. Present Address:

7. Permanent Address

__________________________________

___________________________________

__________________________________

___________________________________

__________________________________

___________________________________

__________________________________

___________________________________

Phone No.: ________________________

Phone No.: _________________________

Mobile:

Mobile:

________________________

_________________________

8. E-mail ID: ____________________________________________________________


9. Do you have Passport? (Yes / No / Applied for) If yes, Number _______________
10. Health: Have you or any of your family members suffered from any major illness /
accident during the last five years? Yes / No

11. Academic Details:


Duration
Degree /
Diploma
Courses

Name of Institute
& Location

Board /
University

Commenced
From
(Month - Year)

12. Language

Speak

Ended on

Division /
Percentage

(Month - Year)

Read

Write

Mother Tongue: ___________


Others: _________________
__________________

13. Work Experience:

Total Years: ___________________


(Please Start with Current Company)
Date

Companys Name &


Location

Designation
From

To

Annual
Salary

Reason for leaving

(CTC)

14. Describe your current Job Profile in brief: ________________________________


______________________________________________________________________
______________________________________________________________________
Whom do you report to? (Designation) _______________________________________
Who reports to you? (Designation) __________________________________________
1. Present Salary Details (Per Month):
Salary per Month
PF
HRA
LTA
Bonus
Other Benefits (Specify)
Deduction (PF, Prof. Tax, Etc.)
Salary in Hand
Total Gross Salary (Per Month)
Note: Please attach photocopy of your last salary slip / appointment letter.
15. Two references: (other than your relatives) We will make such enquiries as it
deems appropriate:
Name:
Address:

Name:
Address:

Ph. No.
(M)

Ph. No.
(M)

I hereby declare that the above information is true to the best of my knowledge
and I shall be solely responsible for any false information furnished by me.

_______________________
(Date)

_________________________
(Signature of Applicant)

You might also like