Jubilant Agri & Consumer Products Limited

____________________

EMPLOYMENT APPLICATION FORM

(Please fill up all the details with Blue colour ball point pen in your own legible handwriting. All columns
should be filled up and mention not applicable [N/A] against those which does not apply to you)

Position Applied For : _______________________________________________

Applied Through : _______________________________________________

AFFIX PASSPORT
(Employee Referral / Consultant / Direct / Advertisements) SIZE COLOR
PHOTOGRAPH
Full Name : _______________________________________________ (Mandatory)
(IN BLOCK LETTERS) (First) (Middle) (Last)

Father’s Name : _______________________________________________

(IN BLOCK LETTERS)

Address For Communication:

_________________________________________________________________________________
_________________________________________________________________________________

City: ____________ District: ________________ State: ______________ Pin Code: _____________

Telephone (Land line) _______ ___ ___ Mobile : +91- _________________ ___
(With STD Code)

Permanent Address:
_________________________________________________________________________________
_________________________________________________________________________________

City: ____________ District: ________________ State: _____________ Pin Code: ______________

Telephone (Land line) _______ ___ ___ Mobile : +91- ________________ ___
(With STD Code)

PERSONAL DATA

Category SC ST OBC GEN Domicile: _____________________

Date of Birth Physical

Place of Birth Home Town Age Height Weight Blood
Date Month Year
(Yrs) (CM) (Kg) Group

Marital Status: Single Married Divorced Date of Marriage: _________

Languages Known: Hindi English Others (Please specify) _____________________

1
FAMILY DETAILS (Describe family members as per Hindu Family Act)
Occupation &
Sl. Name Date of Birth Age Relationship
current Location
No.
1.

2.

3.
4.

5.

6.

ACADEMIC/PROFFESIONAL BACKGROUND (Starting from high school onwards till your last qualification)
School/College Duration
S. Examination Subject/ (Date & Month) %
/Board/Unity/ Division
No. Passed Specialization Marks
Institution From To

1.

2.

3.

4.

5.

Please explain reasons for any intermediate periods when education was interrupted:
_________________________________________________________________________________
_________________________________________________________________________________

ANY PROFESSIONAL SHORT TERM COURSE / TRAINING ATTENDED

Duration Certificate
Sl Institution/ Sponsored by (Month & Year)
Name of the Course awarded
No. Organization (Self/Company)
From To (Yes/No)
1.
2.
3.
4.

2
WORK EXPERIENCE (In reverse chronological order starting from present employment)
Company's/ Duration
S. Position/ Reporting Reasons for
Name & (Month & Year) (Annual CTC)
No. Role Officer Leaving
Location From To
1.

2.

3.

4.

5.

Please use separate sheet, if space given above is less

Total Years of experience : ___________________________________________________

Total No of Job Changes : ___________________________________________________

Organization Structure
Please draw the organization structure of your present Company indicating two levels above & one level
below your position, clearly highlighting your position

Significant Achievements
Highlight at least 3 significant achievements / contributions made by you in your present & previous jobs

Computer Proficiency

3
Have you been unemployed at any time? Yes / NO
If yes, please specify the period and the reasons:
_________________________________________________________________________________

Are you willing to relocate? Yes / NO

If yes, please specify reasons for relocation:
_________________________________________________________________________________
Have you applied earlier in Jubilant? Yes / NO
If yes, Location: _______________ Month & Year: _______________ Source: _________________

Do you have any Friend(s)/Relative(s) working with Jubilant? Yes / NO

If yes, mention Name, Designation, Department and Relationship with employee

_________________________________________________________________________________
Have you ever been charged for criminal offence? Yes / NO

If selected, when can you join? _______________________________________________________

References: List any three persons not related to you to, whom reference can be made and who are
professionally known to you.
Sl.
Name Occupation Address Mobile Number(s)
No.
1.
2.
3.

DECLARATION
I hereby declare that the information provided by me in this application is true to best of my
knowledge and belief and nothing relevant has been concealed. I am aware that any omission,
falsification and misrepresentation above will disqualify me for employment. I understand that if I
am found at any time during my employment, to have concealed or misrepresented any
material/facts or information against any of the above particulars, my appointment in the company
shall be liable for termination at any point of time.

Signature: _________________________ Date: __________________ Place : __________________

For Office use only

Interview Notes/Remarks : ____________________________________________
_________________________________________________________________________________
Appointment details (to be filled by HR) : ____________________________________________
Position details : New / Replacement
Manpower Requisition No. & Date : ____________________________________________
Designation Department/Division : ____________________________________________
Location / Level / CTC : ____________________________________________
Any other comments : ____________________________________________
_________________________________________________________________________________
_________________________________________________________________________________

F3/HR/SOP/002 Corporate HR
4
 PRESENT COMPENSATION DETAILS
Amount
Salary Components
(Per Month)
Basic salary
House Rent Allowance
Conveyance Allowance
Special Allowance
Monthly
Vehicle Maintenance (any other common) Allowance
Salary
Any other (please specify)
1
2
3
Sub Total 1
Leave Travel Assistance
Medical Reimbursement

Annual Guaranteed Minimum Bonus

Benefits Any other (please specify)
1
2
Sub Total 2
Provident Fund

Retirement Superannuation
benefits Gratuity
Any other
Sub Total 3
Hospitalization/ Mediclaim Premium
Personal Accident Insurance Premium
Hard Furnishing
Other
Variable Pay (Incentive) Min and max.
Benefits
Any other (please specify)
1
2
Sub Total 4
Cost To Company (Monthly)
Cost To Company (Annual)