10 Jun 2019033136 PM
10 Jun 2019033136 PM
10 Jun 2019033136 PM
GAIMS
Gujarat Adani Institute
of Medical Sciences
Please affix
recent passport
size photograph
Name:
(Surname) (First name) (Middle name)
Department :
Location :
Page 1 of 8
A. Personal Data
1. Name:
3. Blood Group:
6. E-mail Address:
9. Nationality:
13. Religion:
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17. Languages Known: Mother Tongue:
Read:
Speak:
Write:
2. Registration Details:
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4. Specialized Training / Certification/s:
C. Employment History
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3. Present organization structure:
Kindly circle your position and indicate your reporting relationship i.e. person to
whom you report and who reports to you.
D. General Information:
Year Details
2. What, according to you, are your strengths and areas for improvement?
Strengths:
___________________________________________________________________________________
5. Any other information you would like to offer, including other / personal details /
Special achievements, if any
_
6. Are you prepared to relocate to any of our businesses / locations in India / Abroad?
Yes No
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7. Are you related to any employee / associate of Adani Group?
Yes No
Name(s) : ____
Department: _______________________________________________________________________
Designation: _________________________________________
Note: Please furnish full details of all persons related or known to you. Attach/use
additional sheet if required.
8. Have you been interviewed by us / any of our group companies in the past?
Yes No
Position: ____________
Location: _____________
Company: __________________________________________________________________________
9. Pl give details of any illness / major surgery you may have suffered /
undergone during last 5 yrs., requiring hospitalization / prolonged treatment.
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10. References:
Please give references. (At least, one professional and one personal reference)
Name
Address
Occupation
Contact No.
E Mail
Self-Declaration
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Current Remuneration details:
Please give details of your current remuneration in the first blank column:
Details Per Month Per Annum
Basic Salary
House Rent Allowance
Dearness Allowance
Conveyance Allowance
Fixed Children Education Allowance
Canteen Allowance
Other Allowance
Any Other
TOTAL (A) : Fixed
Petrol Expenses
Medical Reimbursement
LTA / LTC
Reimbursements
Any Other
PF (Employer Contribution)
Superannuation
Gratuity
Retirals
Any Other
Bonus / Ex-gratia
Performance Linked Incentive
Annual / Deferred
Payments Any Other
TOTAL (D) : Annual / Deferred
Payments
GRAND TOTAL
% Hike Expected
Expected CTC
Notice Period
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