Healt , lin CAPITAL letters} | : Candidate Reference Number: (ea Position applied for Aitectal Sthaoul WEE fon Department: Source: Matk a tick in the choices a) Ditect( by Walk-in ( ¢) Advertisement(—) Ld Job portal (—) © Recruitment Consutaney (_); Name of the Consllaney firm z DUGSHC Employee (—) EmpName __F mp Code 8) Any other () Please Specify ityouspy fra jot HGS eater (es oes en _ Have you worked in HGS HC earlier? (Yes /NoyTf yes, when ‘Are you planning to take any leaves within the next 6 months, yes. specity (Ye for Process __., for Process TEERSONAL DETAILS Hema K Tit Name) (iiddle Name) (LastName) Given name (as per 10" Std Mark Sheet) [ Sender Nae Femate [as ag [sean dex Dara os Was Seated eee ae ans ee Teton aS Papo Na ES [anti acoranor arma —| Fre AUG A eos wamer” CIS StS » loth Grog FEUD) TORS CEORR An Nes we jon Ire DEAD Naqgeabave Barglove ee a ett seen reery| mae AT SSG TAT rsNane —V oSuetes Tieatip LBaeien Con psa Teena dy oe ogmartes Mag] Permanent Aduress & telephone number Name: “Rarevah| Rarzammatl r ee S3h9 |e] olfes|igeto : a ae Eee Biss Gor onel oFve J. EDUCATIONAL QUALIFICATIONS (start with your 10" Std onwards) : : Name pithe Schoo? | Board! Pefog [lots Sa Percentage? College / University University | oy To _| posteGraduation | SP&itlization | pivision/ Grade MESENQUGH | KSEEB ois [dole | tor | SoG | ag KLE “IND WV COMG Pre-wuaRersiidold [Pols | 1th [| PCM, q\ Ber BSOINETTE TY [So [odd | E BO Version ha t Y Pron got Scanned with CamScannerEMPLOYMENT APPLICATION FORM oyment) ML EMPLOYMENT DETAILS: (Please start with your current en Reporting to: Achievements, ifany Tast dra salary (Cost tothe company Rs, p.a), Notice period Nave you signed any bond? Reasons for change Employment 2: ‘Name of the Company’ Position Held Reporting to: ‘Total Experience in Months Period ofemployment | FF0™= Ter Job Description Achievements, ifany) ast drawn salary (Cost to the ] ‘company Rs. p.a.) Reasons for change * Add additional sheets, if last 10 years is not covered in previous 2 employers. ‘Are you part of any Social / Cultural / Religious / Political / NGOs / Charity groups ? Ifany, please provide the details es. Cockency 5 TToaneetling Do you know anyone who is presently an employée ai HGS HealthCare? If yes, kindly mention the details, Please indicate your hobbies / interests / extra-curricular activi Name: Contact No, Designation Department / Process : Relationship: IV. MEDICAL HISTORY: Have you ever suffered from any disability or any stress related injury or been diagnosed as suffering from any terminal illness? If yes please provide details. : = es Page 2013 Scanned with CamScanner Version 1.4history of du, alo bus any treatment with rele , eqnession, and for any other psycholigieal disorder? Ifyes please provide nt dates. REFERENCE DETAIL Please provide the details of two references (not related and not employed in HGS HC) who are known to you: Reference |: 7 Reference 2: Name Name Company = Company | | Designation Design Tow is this person known Tow is this person | 10 you? [known to you? Contact Numbers Contact Number: Email id: Email VL PROSECUTION STORY: Have you ever been tried & convicted by any court of la on grounds including ev ‘other acts punishable under the Information Technology Act? If yes, please provide’ Brief History ofthe case: Court Trying the offence: ‘fan order has been passed by the court, please provide details ofthe ‘order with the date that it was passed: VII DECLARATION : I hereby accord the company my voluntary consent to carry out such background verification, credit, eriminal, edueational and fraud checks as the company may deem fit, in the best husiness imeress ofthe company. I have also been provided with sufficient time to read, understand and consul with counsel the contents and declarations required inthis form & I have signed it free of any coercion, I hereby state that I'm not suering from any ailment, iliness that would impaet my performance in any manner whatsoever. 1 hereby state that all the representations made herein are rue tothe best of my knowledge, information and belief and that | have misrepresented gny facts hetein, and also understand that the company’ hereby reserves its rights to take such action Any nlstepresentations as it may deem it and is allowed under applicable la, including using this application and the d therein by me as a deenied sworn affidavit ‘understand that if | eave within one year the company will ecover the expenses it has incurred on relocating me. I agree to give ‘company adequate notice as per the terms and conditions of my employment, when I resign oR oae:16_ [08] sov9 Signature ofthe Candidate ‘Version 1.4 = Page Jot 3 Scanned with CamScanner