AFFIX

PASSPORT
SIZE PHOTOGRAPH
ONLY ON HARD
COPY
CANDIDATE INFORMATION & NOMINATION FORM (SIZE: 4.5cm X 3.5)
www.india.amazon.com
Please provide all information requested. A partially filled application will not be accepted for review. Amazon India is an equal
opportunity employer, and does not discriminate on the basis of race, religion, caste, creed, color, national origin, citizenship, marital
status, sex, age, sexual orientation, veteran status, political ideology, ancestry, the presence of any physical, sensory or mental
disabilities, or other legally protected status. Information provided on this application will not be used for any discriminatory purposes.
Amazon India complies with all applicable nondiscrimination laws and regulations.
SECTION I

APPLICANT DETAILS
First Name: Middle Name: Last Name:

Father ‘s Name: Mother ‘s Name: Spouse ‘s Name:

Date of birth: Country of Birth: Citizenship:

(dd/mm/yy)
Home Phone: Cell Phone: Email Id:

Gender: Marital Status: Blood Group:

Have You ever been known by another name?
Yes
No

If yes, kindly specify:
(Ladies: Please mention your maiden name if different and applicable)

For Indian Nationals Only: IMPORTANT: Please attach either copy of Passport or Voter ID card or Birth Certificate Or Aadhaar Card

Indian Passport No: Issued At ( City ): Valid from: Valid until:

Voter ID Card No: Issued At ( City ):

Birth Certificate No: Issued At ( City ):

Aadhaar Card No: Issued At ( City ):

For Non-Indian Nationals: IMPORTANT: Please attach copy of Passport and Visa

Passport No: Issued At ( City ): Valid from: Valid until:

Indian Visa No: Issued At ( City ): Valid from: Valid until:

American Nationals - State SSN number:

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For Person of Indian Origin / Overseas Citizen of India: IMPORTANT: Please attach copy of PIO Card / OCI Certificate

PIO / OCI No: Issued At ( City ): Valid from: Valid until:

EDUCATIONAL DETAILS AND SKILLS Start with the latest/ highest qualification;
IMPORTANT: Please attach photocopies of Mark sheets & Certificates of all the qualifications
Roll Number/
Name & Address of School/College/ Registration
Qualification Obtained Year Attended Date Awarded
Institute Number/Exam
From - To
Seat number

(Post-Graduation)

(Graduation/Diploma)

(Class XII)

(Class X) (Year of Passing)

Special Studies/Training:

Note: If you have additional qualifications beyond the listed above kindly furnish the same as an annexure to this document as per
details furnished above.

EMPLOYMENT RECORD
Please list your Two most recent employers or all employers during last two years of employment whichever is greater,starting with
most recent one first. Use additional pages if necessary.
Are you currently employed?  Yes  No; if yes, may we contact your current employer?  Yes  No
If you indicate no, your current employer will be contacted once you join Amazon.
EMPLOYMENT 1 IMPORTANT: Copy of Offer letter or Current Salary Slip MUST be attached
Name of the employer
Address

City
Telephone Number
Job Title
Dates of employment From To
Employee ID #
Reason for Leaving
HR Manager’s Name

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HR Manager’s contact details E-Mail : Phone:
Manager’s Name
Manager’s contact details E-Mail : Cellular:

EMPLOYMENT 2 IMPORTANT: Copy of Relieving Letter or Experience Letter MUST be attached

Name of the employer
Address

City
Telephone Number
Job Title
Dates of employment From To
Employee ID #
Reason for Leaving
HR Manager’s Name
HR Manager’s contact details E-Mail : Phone:
Manager’s Name
Manager’s contact details E-Mail : Cellular:
Note: If you have work experience beyond 2 employers kindly furnish the same as an annexure to this document as
per details furnished above.
The purpose of this form is to notify you that a credential check report will be prepared on you in the course of consideration of
employment with Amazon.
Past employers, education institutions, law enforcement agencies and other entities, for positive identification purposes require the
following information for positive identification when checking public records. This information is confidential and will not be used for
any other purposes.
In connection with this request, I hereby authorize all corporations, former employers, credit agencies, educational institutions, law
enforcement agencies, city, state, county and federal courts and military services to release information about my background
including but not limited to information about my employment, education, credit history, driving records, criminal records, general
public records to the person or company with which this form has been filed or their assigned agents thereof. My signature, below
releases the aforesaid parties or the company or the individuals releasing the information from any liability whatsoever in collecting and
disseminating the information obtained. Further, in accordance with the host nation laws regarding the release of information, the Data
Protection Privacy Act, the European Privacy Act and others, I authorize the transmittal and release of information to the above
agencies and my employer in any country.

Checklist of documents : whichever is applicable as per your inputs in the above pages

Passport Copy
Indian Voter ID Copy
Aadhaar Card Copy
Birth Certificate Copy

One recent Passport Size Photograph in hard copy ( scanned image is
12th Class Marks sheet
not required)

Post-Graduation Certificate and Mark

Graduation Certificate and Mark sheets sheets

Employment Relieving Letters
Latest Pay Slip
Non-Indians:
Visa Copy
PIO Card Copy
OCI Certificate Copy
Signature Date

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 SECTION II
APPLICANT CONTACT INFORMATION:
Permanent Address

City State
Postal Code Land Mark:
Residing Since( Mandatory) Nature Of Location: Rented/Owned/Others
Current Address

City State
Pin Land Mark:
Residing Since(Mandatory) Nature of Location Rented/Owned/Others

Name and Address of person to be contacted in case of an emergency:

Contact Person:
Emergency Contact Number:
Relationship:

Bank Details (Applicable only if you have Salary account with ICICI Bank, State Bank of India, HDFC Bank & Citibank)
Name As Per Bank Records
Bank Name Branch
Account Number
IFSC Number

Permanent Account Number (Pan Card) IMPORTANT: Copy of PAN Card MUST be attached.

PAN Card Number

Note: In case you do not have a PAN card, please apply for the same here
(https://tin.tin.nsdl.com/pan/form49A.html) and provide the PAN Acknowledgement Number here.

Nomination for PF/Gratuity/Accident & General Insurance and others

I hereby declare the name (s) of the nominee(s) who will receive all payments as legal heirs in the event of any eventuality.
Sl. No: Full Name [Legal Name] Relationship Date of Birth [DD/MM/YYYY]

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EMPLOYMENT DESIRED (If position is unknown, please enter Associate)
Position Desired Location Wage Desired Expected Joining Date

Are you able to perform the essential functions of the job with or without reasonable accommodation?  Yes  No
Are you able to travel if necessary?  Yes  No

Wage Information ( Please specify currency ) :

Wage Information:
Starting Ending

Base Salary ___________ ___________

Overtime ___________ ___________

Bonus ___________ ___________

Shift Pay ___________ ___________
Stock Options ___________ ___________
Similar Consideration ___________ ___________

Gross Salary ( Annual in words ):

REFERENCES: If not submitted separately, please give below the names of five references whom you have known for at least one
year. Professional references are preferred.
1. Name: Contact Number: How do you know this person? Years
acquainted?
E-Mail Address:
Employer Name and Location:

2. Name: Contact Number: How do you know this person? Years

acquainted?
E-Mail Address:
Employer Name and Location:

3. Name: Contact Number: How do you know this person? Years

acquainted?
E-Mail Address:
Employer Name and Location:

4. Name: Contact Number: How do you know this person? Years

acquainted?
E-Mail Address:
Employer Name and Location:

5. Name: Contact Number: How do you know this person? Years

acquainted?
E-Mail Address:
Employer Name and Location:

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• Are you legally authorized to work in India?  Yes  No
Please choose below the basis of your employment authorization
Indian Nationals:  by Indian Citizenship
Non-Indian Nationals:  Work Visa  Person of Indian Origin Card  Overseas Citizenship of India Certificate

• Are you subject to a non-competition agreement or other agreement, which would preclude or restrict your
employment at Amazon India?  Yes  No

If yes, please describe: __________________________________________

• How were you referred to Amazon India?

 “Walk In”  Internet/Web  Agency: (Please indicate)  Ad: (Please indicate paper or ad code)

 Conference/Job Fair: (Please indicate specific conference or job fair attended)

 Amazon Employee Referral: (Name of the employee)  others: (please specify)

• Have you applied previously to any Amazon.com company?

 Yes  No If yes, please give date(s):________________________

• Have you been employed previously by any Amazon.com company?

 Yes  No If yes, please give dates of employment: ____________

I hereby authorize Amazon India to verify and investigate my employment, history and to inquire of my current and former employers
and references information concerning my work history, character and ability, as Amazon India deems necessary. I hereby permit
Amazon India and its representatives in seeking such information and all other persons, corporations or organizations for furnishing
such information. In this regard, I agree to sign as a condition of my employment any and all releases not specified here, but which
may be required under law, to implement this background check. If I become employed, I release Amazon India from any and all
liability that may arise as a result of any future references it may provide concerning my employment with the company. I further
agree to hold harmless and indemnify Amazon India and its employees and agents from and against any and all liability arising out of
such background investigations.

The above information is true and correct to the best of my knowledge. I understand that false statements or material omissions of any
kind during the hiring process may result in denial of employment or discharge.

I understand that I will be required to sign a confidentiality and non-compete agreement.

I understand and agree that if I am employed, I shall be employed on an at-will basis. As an at-will employee, I understand and agree
that Amazon India can terminate our employment relationship, at any time for any reason, with or without advance notice and with or
without cause.

I further understand that nothing contained in this employment application or in interview process is intended to create an employment
contract between Amazon India and me.

I acknowledge that no representation or promise regarding the duration or the termination of employment with Amazon India is
authorized or binding unless contained in a written document signed by an officer of Amazon India.

If employed, I further agree and consent that any wages or other monies which may be due me may be applied against any
indebtedness I may have incurred to Amazon India

Signature of Applicant Date___________________________

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