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Job Requisition No.: Position Applied For: Location:: Personal Data

The document appears to be a job application form that collects personal details such as name, address, family details, education history, employment history, languages spoken, and a declaration authorizing background checks and confirming the accuracy of the information provided. The applicant is asked to provide details such as their name, photo, date of birth, address, family, education, employment history, references, languages, and previous applications to the company.

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Einstein Amirtharaj
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69 views3 pages

Job Requisition No.: Position Applied For: Location:: Personal Data

The document appears to be a job application form that collects personal details such as name, address, family details, education history, employment history, languages spoken, and a declaration authorizing background checks and confirming the accuracy of the information provided. The applicant is asked to provide details such as their name, photo, date of birth, address, family, education, employment history, references, languages, and previous applications to the company.

Uploaded by

Einstein Amirtharaj
Copyright
© Attribution Non-Commercial (BY-NC)
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
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Job Requisition No.

: Position Applied for: Location:


PERSONAL DATA (FILL IN CAPITAL LETTERS)
Name:
(Salutation) (First) (Middle) (Last)

Please attach a recent passport size photograph

Name to appear in the Appointment Letter as: Date of Birth:


(mm/dd/yyyy)

Marital Status: ______________


(Married / Single)

Gender:

(M / F)

Present Address: __________________________________ __________________________________________________ __________________________________________________ City: ____________________State: ___________________ Pin: ______________ Telephone: (____)______________ Emergency Contact Details Name of Person 1) 2) FAMILY DETAILS

Permanent Address: ___________________________ ______________________________________________ ______________________________________________ City: _________________ State: _________________ Pin: _____________ Telephone: (___) _____________ Mobile: ______________ E-mail: _________________

Contact Number

Name

Age

Relationship

Occupation

Category (C) and Religion (R) General ( SC ( ) ST ( C R


) Hindu ( ) Muslim ( )

OBC ( Sikh (

) )

Others:____________________ Jain ( ) Buddhist ( ) Other:_________________

Christian( )

EDUCATIONAL DETAILS

Details Post Graduation/ Degree Specialization Institute name

Std. X

Std .XII Diploma

Graduation/ Others

----NA----

-----NA-----

University/Board name

Date of Passing (month - year) Percentage/CGPA (Only if completed)

EMPLOYMENT DETAILS
Please start with your most recent employment Industry Organization Name* Address*
Current Employer Previous Employer

ADDITIONAL (mm/dd/yyyy)* EMPLOYMENT DETAILS Date of Joining PROFESSIONAL REFERENCES


Date of Leaving (mm/dd/yyyy)* Designation Employee Number Reporting Manager's Name Reporting Managers Contact Details Last Drawn Salary (p.a.)* Reason for Leaving HR Manager's Name

HR Managers Contact Details

Languages

Speak

Read

Write

Have you applied to ICICI and its group companies before? If so, please name the position you applied for and when? (In case you have been an advisor with ICICI Prudential Life Insurance Company Ltd, please mention)

Do you have any relatives in ICICI Group Companies? If so, please fill the following Name of Relative Designation Company

I HAVE
I have applied to ICICI Prudential through ( Source Consultant Referral / Talent hunt Pinnacle Direct Applications Others (please specify) Employment is contingent upon your being found medically fit by a certified physician. fill all details if applicable ) Contact Details Employee id

Source Name

I hereby authorize ICICI Prudential (or a third party agent appointed by the Company) to contact any former employers as indicated above and carry out all Background Checks not restricted to education and employment deemed appropriate through this selection procedure. I authorize former employers, agencies, educational institutes etc. to release any information pertaining to my employment/education and I release them from any liability in doing so. In order to complete my verification, I agree to submit Education certificates/mark sheets, experience certificate from last employer and permanent address proof. I confirm that the above information is correct to the best of my knowledge and I understand that any misrepresentation of information on this application form may, in the event of my obtaining employment, result in action based on company policy.
I also affirm that I have not been involved in any unlawful and illegal activities. Date: ________________________ Signature:

Place: _________________________ _____________________

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