Hindustan Salts / Sambhar Salts Limited (A Government of India Enterprise) Application for Employment

Before filling in please read carefully instructions on the last page.

Name of the Post___________________________________ Pay Scale Rs.____________________________ Employment Notice No.____________________

PERSONAL DATA

1.

(a) (b)

Name in full__________________________________________________________ (In Capital Letters Underline Surname) Fathers / Husbands Name______________________________________________ Occuption____________________________________________________________

2.

(a)

Present Postal Address_________________________________________________ ________________________________________________

(b) (c) (d)

Telephone Number : Office______________________Resi_____________________ Mobile No.____________________________ Email ID_______________________ Permanent Address____________________________________________________ ____________________________________________________

(e) 3 (a) (b) (c) 4. (a) (c)

Home Town__________________________________________________________ Date of Birth__________________________________________________________ Exact Age____________________________________________________________ State to which you belong____________________________________________ Nationality ______________________ (b) Whether Schedule Caste Yes / No or Religion___________________ Schedule Tribe Yes / No

Registered Office : B-427, Pradhan Marg, Malviya Nagar, Jaipur (Raj.)-302017

(d)

Whether released RCO/ECO/SSCO - Yes / No if yes, details of _____________ (i) (ii) (v) (vi) Rank_________________ (ii) Crops / Regiment No.____________

Date of Commission_________ (iv) Date of Discharge______________ Date of start of Pre-commission training, if any_____________________ Education in the Miltary_______________________________________ - Male / Female (f) Marital Status - (Single/ Married/ Widowed/ Divorced / Separated) S.No. Name Age Relationship

(e)

Sex

(g)

No. of Dependents :

(h) (i) 5.

Heights :________________ Weight__________________ Chest____________ Power of glasses, if used- Right__________________ Left______________

ACADEMIC & PROFESSIONAL QUALIFICATIONS Details of Academic & Professional Qualifications (Matriculation onwards) (Also mention details of statutory qualifications, if any, required for the post)
College / Institution Year of Joining Year of leaving / passing Board / University Class / Division % of marks obtained Main Subject studied Remarks

Examination/ Degree passed

6. Proficiency in Computer Literacy & qualification acquired. Name of qualification Year of Description of the obtaining course

Remarks, if any

7. Proficiency in Languages Language Can Read

Can Write

Can Speak

TRAINING & ATTAINMENTS 8. Details of Training / Apprenticeship etc. S.No Name of Nature of From To Examination Institute or Training or Passed, if Employer Apprenticeship any

Pay/ Stipend., if any

PARTICULARS OF EXPERIENCE 9. 10. Total experience____________ (__________years____________ months) Details of experience starting from present position.
Period of Employment From To Durati Date date on Yr. Mths. Designation and scale of pay Basic Pay Total Emolu ments Exact Nature of Duties Reason for leaving

Employers name & Complete address (Start from present Employer)

GENERAL INFORMATION 11. Salary Details of Present Position held ( As on Date of the Application) Scale of Pay Basic Spl. Pay DA CCA House Any other Pay Allowance Rent cash Allowance allowance

Gross Earnings per Month

12.

If retired from Govt. / Defence Services, give details of pension / equivalent of Pensionary benefits

13. Basic Pay acceptable in position applied for

Minimum time required to Join, if selected

14.

Have you been an applicant for any post in this Company before ? if yes, state the name of the post and whether interviewed or not ? give date of interview. Are you prepared to serve anywhere in India. Have you ever been arrested in a criminal case or convicted, fined or imprisoned for violation of any law (excluding minor traffic violation) or is any disciplinary / vigilance case pending /ever instituted against you or have you been barred /disqualified by a Public Service Commission university or any other educational authority from appearing in its exam. If so, give details.

Yes/ No

15. 16.

Yes/ No

Yes / No

17.

Is any of your relatives employed in HSL / SSL ? Or are you related to any of the Directors of the HSL ? if yes, please give the following details :His / Her Name Relationship Occupation Where employed

18.

Have you ever been abroad ? if so give following particulars :Country Visited Date of Arrival Date of Departure Duration of stay Purpose of visit

19.

EXTRA CURRICULAR ACTIVITIES :

20.

Details of Books / Papers & etc., published, if any.

21.

References :(These persons should be resident in India and holders of responsible positions and they should be intimately acquainted with applicants character and work but must not be relations)

Name

Address

Occupation or Position

21.

Any other relevant details / information not covered above, that you may wish to furnish.

22.

List of documents attached. (True copies)

I CERTIFY THAT : (a) (b) (c) (d) The information furnished above is correct. I am / am not employed in Govt. / Statutory Organisation / Public Sector Undertaking. My application has / has not been forwarded through proper channel. I am ready to join the Company after resigning the post / retaining protective lien on my present post in Government / Public Sector Undertaking.

Note : Delete whichever is in applicable. Dated._______________ (FOR OFFICIAL USE ONLY) The entries regarding age, qualifications, etc., made above have been verified by me with the originals and found correct. Signature of Applicant

PERSONNEL OFFICER / OFFICE SUPDT.

INSTRUCTION FOR FILLING THE APPLICATION FORMS Kindly make sure that all the instructions given below are complied with, failing which, your application is liable to be rejected. 1. 2. All entries in this form should be typed or written neatly. Submission of this form involves no commitment no either side and no correspondence with regard to the suitability or otherwise of the applicant will be entertained. Application forms from employees of Government / Public Sector Undertakings/ Statutory Organisations must be sent through proper channel. Incomplete application will not be considered. Attested copies of certificates and testimonials should be attached with the form. All enclosures to the application form should preferably be of the size of application form and all the sheets be properly stitched or tagged. Original Degree / certificate/Testimonials should not be sent. The name of the post applied for should be clearly indicated on the right hand corner of the envelop. All the information given in the application form should be correct. Any mis-statement of facts would render the candidate liable to rejection and termination after appointment. Any change in address should be communicated to us. While every care would be taken to record the change in address, the Company will not accept any responsibility, whatsoever for delivery of interview letter on changed address. The candidate should therefore arrange for redirection of communications to their changed address. A recent passport size photograph should be affixed on the application form. A crossed Indian Postal Order of required amount should be attached with the application form if not sent earlier, failing which the application will not be entertained. The application fee is not refundable. Ex-Servicemen are not required to pay application fee. Candidates belonging to Schedule Caste / Schedule Tribe communities should invariably attach copy of the certificate from one of the following authorities. (j) District Magistrate / Additional District Magistrate / Collector / Deputy Commissioner / st Additional Deputy Commissioner / Deputy Collector / 1 Class stipendiary Magistrate / City Magistrate * / Sub Divisional Magistrate / Taluka Magistrate / Executive Magistrate / Extra Assistant Commissioner. st * ( Not below the rank of 1 Class Stipendiary Magistrate) (ii) (iii) 13. 14. Revenue Officer not below the rank of Tehsildar. Sub-Divisional Officer of the area where the candidate and / or his family normally resides.

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Canvassing in any form will lead to disqualifications. Extra Sheet should be added wherever space is insufficient.