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Personal Data Form

This document is a personal data form requesting information such as name, date of birth, address, education history, work experience, references, and a declaration. The form requests a passport photo and photocopies of certificates. It collects details including family background, languages known, extracurricular activities, positions held and responsibilities, references, indebtedness and convictions. The applicant declares their willingness to take up assignments anywhere and that the information provided is true to their knowledge.

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mohan
Copyright
© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
366 views

Personal Data Form

This document is a personal data form requesting information such as name, date of birth, address, education history, work experience, references, and a declaration. The form requests a passport photo and photocopies of certificates. It collects details including family background, languages known, extracurricular activities, positions held and responsibilities, references, indebtedness and convictions. The applicant declares their willingness to take up assignments anywhere and that the information provided is true to their knowledge.

Uploaded by

mohan
Copyright
© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
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PERSONAL DATA FORM

Affix one
Passport Size
Photograph

Name:

Post :

 Please complete this form in your own handwriting. Avoid overwriting and erasing.
 Please enclose photocopies of Certificates and Testimonials.
 Please answer all items completely. If necessary attach separate sheets and add any
additional information that may be relevant.
_____________________________________________________________________________________
A. Personal Particulars:
Full Name (Block Letters) Surname
Father’s/ Spouse’s Name:
Date of Birth: Gender: Age:

Place of Birth: Town: Taluk: Dist.: State:

Marital Status Blood Group


Religion

Nationality

Height Weight
Identification Marks

Physical Disability if any

Prolonged Sickness if any

Permanent Address
With Telephone No.
Email address

Mailing Address

With Telephone No.


Email ID
B Family History (Background):

Name Age Occupation


Son(s)
Daughters
Brothers
Sisters

Father / Spouse Name


If Employed occupation and Address

C. Educational Particulars (SSC / Matriculation Onwards):

Exam Medium Name & Address Year of Year of Month & Main subjects Div/ Total %
Certificate of of the Institution Entering Leaving Year of Class of
/Degree/ Institution Passing obtained marks
Diploma

Languages Known: [Please (Tick) mark]

S.No. Name of the Language Speak Read Write

1.

2.
3.

4.
Scholarships / Awards / Recognitions
obtained, if any:

Training Special courses attended, if any:

Name of the Conducted at From To Subject / Topic


College / Institution & by

Publication and Papers presented (including Thesis) :

D. Extra – Curricular Activities:

Literary / Cultural Arts


Social
Sports & Games
Hobbies

Member of Cultural, social, Professional Organization:

Name of the Organization Nature of Association


E. Experience and Past Employment:

Total Employed Salary on Leaving


Employers’ Name Reason for
Designation Period of Basic Total
& Address From To leaving
Service Salary Emoluments
Present

Next last

Third last

Fourth last

Nature of responsibilities under each employer:

Nature of responsibility under each employer Reported to


Name & Designation

1.

2.

3.

4.
F. References
Two references not related to you, of whom at least one should be holding a responsible
position in the line of your occupation, preferably your present or past employer. In case
fresh from college, give the name of the Principal of the College last attended.

Nature of Reference Occupation Address

Name and address of 2 responsible persons of your locality to whom you are known:

Nature of Reference Occupation Address

General and material indebtedness, if any


Have you been convicted by any court of law

DECLARATION

I am willing to, if and when required, take up casual, temporary, permanent duty in discharge of
Company assignments anywhere in India or abroad.

I certify that the above information is correct and complete to the best of my knowledge and belief and
nothing has been concealed. If, at any time, I am found to have concealed any material information or
give any fake details, my employment is liable for summary termination without notice or compensation.

Place :
Date : SIGNATURE OF APPLICANT

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