ApplicationForm 12165871

Interview Location
Kolkata(wb)
Candidate Id
1006879986
Please ✓ in the ❑ wherever applicable.

Please answer each column fully and neatly in your own hand-writing.
APPLICATION FOR EMPLOYMENT
PERSONAL DETAILS
NAME IN FULL
(in block letters)
(As it appears on passport / legal document)
NILANJAN MUKHERJEE
FIRST MIDDLE LAST
ADDRESS FOR COMMUNICATION
14B2 ANANTADEB MUKHERJEE LANE Mobile No : +91-7044492539
SHIBPUR HOWRAH Pan Card No : XXXXXX990D
E-mail: [email protected]
(Personal E-Mail ID only)
City HOWRAH CITIZENSHIP(S) :
PIN / POSTAL CODE 711102 India
State : West Bengal DO YOU HAVE A PASSPORT?:
YES: R NO: ❑
Country India
DATE OF BIRTH (as per passport / legal document) :

(dd/mm/yyyy) GENDER:
12/04/1997 MALE R FEMALE ❑ OTHER ❑
VER 9.2 1 of 4 HRD/REC/2023
SIGNATURE OF THE APPLICANT

EDUCATION
LEVEL DIPLOMA/EQUIV GRADUATION POST OTHER
(If applicable) GRADUATION
(If applicable)
Name Of The Qualification Diploma of Computer Science BTech
Awarded
State Board / University West Bengal State Council Of Maulana Abul
Technical Education Kalam Azad
University Of
Technology-k
Name of School/College Budge Budge Institue of Dr Sudhir
Technology Chandra Sur
Degree
Engineering
College
State
Branch/ Stream / Area Of Computer Science & Technology Computer
Specialization Software
Engineering
*Percentage / CGPA 98 85
Year & Month Of Final June 2018 November 2021
Examination
*ALL PERCENTAGES / CGPA SHOULD BE AS PER THE DEGREE CERTIFICATE OR FINAL YEAR MARKSHEET (Documents
will be checked during interview round.)
GAPS IN EDUCATION (If any) 0 years. Reason: NA
WORK EXPERIENCE
PLEASE WRITE 'NA' IF NOT APPLICABLE
SPECIFY CLEARLY IN CASE OF PART TIME/CONTACT WORK EXPERIENCE NOTICE PERIOD REQUIRED : 1 Days
PERIOD (MM/YYYY)
PAYROLL FROM TO DURATION DESIGNATION REASON FOR EXPERIENC
ORGANIZATION* (in months) SEPARATION E/
RELIEVING
LETTER
AVAILABLE
(Y/N)
Tata Consultancy Services 19-12-2021 25 System Less Salary N

Administrator
GAPS IN EXPERIENCE (If any) 0 years. Reason: NA
* Please do specify "Payroll Organization" if you are working on a contractual basis
Disclaimer : Please be informed that work experience provided by you will be validated through Background check

COMPENSATION AND BENEFITS
ANNUAL CURRENT NEXT REVISION YOUR EXPECTATION AT
EXPECTED DATE: INFOSYS
18-02-2024
Fixed Salary in Lakhs 3.40
(INR)
Variable Pay in Lakhs 1.00
(INR)
Other Benefits in Lakhs
(INR)
Annual Gross 3.50 3.50 6.50
Compensation in Lakhs
(INR)
MISCELLANEOUS
HAVE YOU UNDERGONE ANY SELECTION PROCESS WITH INFOSYS OR INFOSYS GROUP COMPANIES YES ❑ NO R
(LIKE INFOSYS BPM, ETC.) PREVIOUSLY?
MONTH & YEAR
- TAKEN ANY TEST? YES ❑ NO R ................

- SELECTED FOR INTERVIEW? YES ❑ NO R ................
- MADE AN OFFER? YES ❑ NO R ................
- JOINED & QUIT? YES ❑ NO R ................

ARE YOU SERVING/ENGAGED AS A DIRECTOR, PARTNER, SOLE PROPRIETOR OR IN ANY OTHER YES ❑ NO R
EQUIVALENT POSITION IN ANY COMPANY, FIRM OR BUSINESS ENTITY?
IF YES, PLEASE PROVIDE THE DETAILS
ARE YOU CURRENTLY EMPLOYED WITH ANY OF THE INFOSYS GROUP COMPANIES? YES ❑ NO R
IF YES, INFOSYS BPM ❑ OTHERS ❑ PLEASE SPECIFY
HAS ANY WARRANT FOR YOUR ARREST OR SUMMONS FOR YOUR APPEARANCE BEEN ISSUED OR YES ❑ NO R
AN ORDER PROHIBITING YOUR ENTRY INTO OR EXIT FROM ANY COUNTRY, BEEN ISSUED BY A
COURT OF LAW OR ANY GOVERNMENTAL AUTHORITY?
HAVE YOU AT ANY TIME BEEN SUBJECT TO OR ARE BEING SUBJECT TO ANY INVESTIGATIONS BY YES ❑ NO R
THE FINANCIAL MARKET REGULATOR SUCH AS SECURITIES AND EXCHANGE BOARD OF INDIA?

ARE YOU AWARE OF YOU BEING SUBJECT OF ANY INVESTIGATION BY ANY GOVERNMENTAL YES ❑ NO R
AUTHORITY?
ARE THERE ANY CRIMINAL PROCEEDINGS PENDING AGAINST YOU BEFORE ANY COURT OF LAW IN YES ❑ NO R
INDIA OR OUTSIDE INDIA?
ARE YOU SUBJECT TO ANY *SANCTIONS LAWS? YES ❑ NO R
[*SANCTIONS LAWS MEANS ALL APPLICABLE FINANCIAL, ECONOMIC AND TRADE SANCTIONS
(WHETHER PRIMARY OR SECONDARY), AND EXPORT CONTROL LAWS AND REGULATIONS (OR ANY
SIMILAR RESTRICTIONS) IMPOSED BY THE UNITED NATIONS OR THE GOVERNMENTS OF
AUSTRALIA, THE UNITED KINGDOM, EUROPEAN UNION AND THE UNITED STATES OF AMERICA OR
ANY OTHER COUNTRY]
ARE YOU UNDER ANY LEGAL OBLIGATION TO YOUR CURRENT EMPLOYER? YES ❑ NO R
IF YES, IN SIGNING THIS VERIFICATION AND AFFIRMATION REGARDING CONTRACTUAL
RESTRICTIONS, I AFFIRM THAT THERE ARE NO CONTRACTUAL RESTRICTIONS ON THE
ABILITY OF INFOSYS TECHNOLOGIES LTD. TO HIRE ME TO PERFORM THE POSITION FOR
WHICH I MAKE APPLICATION. I HEREBY AGREE TO RELEASE INFOSYS TECHNOLOGIES
LTD FROM ANY SUIT/CLAIMS MADE BY ANY OF MY PREVIOUS EMPLOYER(S) ARISING
OUT OF VIOLATION OF ANY CONTRACTUAL LEGAL OBLIGATIONS WITH THEM.
DECLARATION
I authorize Infosys to conduct investigation to verify facts of all statements made in this application and my supporting
documents. I authorize Infosys to secure information about my experience from former employers, educational institutions,
government establishments/agencies or any references I have provided, and for those parties to provide information
concerning my qualifications for employment and I hereby release all parties from any liability arising from such
investigation.
I certify that the academic marks / CGPA are simple average for all subjects / semesters / years including electives, optional
subjects, additional subjects, practicals and languages.
I understand that if I am employed with the company, any false statement, misrepresentation, or omission of facts on this
application or on any supporting documents, regardless of when discovered if found to be false, may result in my immediate
dismissal. The company will have the right to withdraw my letter of appointment or to terminate my training/subsequent
appointment at any time without notice or compensation.
My signature below certifies that I have read, understand, and agree to the foregoing and to the best of my knowledge and
belief; the information on the application form is true and correct.
Date : ........................... Place : .......................... Signature: .............................

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Interview Location

Please ✓ in the ❑ wherever applicable.

APPLICATION FOR EMPLOYMENT

FIRST MIDDLE LAST

ADDRESS FOR COMMUNICATION

14B2 ANANTADEB MUKHERJEE LANE Mobile No : +91-7044492539

SHIBPUR HOWRAH Pan Card No : XXXXXX990D

(Personal E-Mail ID only)

City HOWRAH CITIZENSHIP(S) :

PIN / POSTAL CODE 711102 India

State : West Bengal DO YOU HAVE A PASSPORT?:

DATE OF BIRTH (as per passport / legal document) :

12/04/1997 MALE R FEMALE ❑ OTHER ❑

VER 9.2 1 of 4 HRD/REC/2023

SIGNATURE OF THE APPLICANT

GAPS IN EDUCATION (If any) 0 years. Reason: NA

Tata Consultancy Services 19-12-2021 25 System Less Salary N

GAPS IN EXPERIENCE (If any) 0 years. Reason: NA

* Please do specify "Payroll Organization" if you are working on a contractual basis

VER 9.2 2 of 4 HRD/REC/2023

SIGNATURE OF THE APPLICANT

- TAKEN ANY TEST? YES ❑ NO R ................

- JOINED & QUIT? YES ❑ NO R ................

VER 9.2 3 of 4 HRD/REC/2023

SIGNATURE OF THE APPLICANT

Date : ........................... Place : .......................... Signature: .............................

VER 9.2 4 of 4 HRD/REC/2023

SIGNATURE OF THE APPLICANT

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