Application Form: Position Applied For

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( PLEASE STAPLE A

RECENT PASSPORT
SIZED PHOTOGRAPH )

APPLICATION FORM
PLEASE READ THESE INSTRUCTIONS CAREFULLY
1 Do not leave any item blank. If it is not applicable to you, indicate "N.A."
2 Please attach a scanned copy of your passport showing all relevant details.
3 False particulars or willful suppression of material facts will render you liable to disqualification, or, if appointed,
to termination and/or appropriate legal proceedings.

Position Applied For


Name

:
Title

First

Middle

Family / Surname

Present Postal Address

Permanent Postal Address

Residence Tel.

Residence Tel.

Office Tel.

Office Tel.

Mobile Tel.

Mobile Tel.

Fax

Fax

Email Address

Email Address

Page 1

Personal Details
Date of Birth

Place of Birth
D

Country

Nationality at Birth

Height

Nationality at Present

[ In Cms. ]

Do you hold Dual Nationality?

Yes

No

City

Weight
[ In Kgs. ]

If Yes, please specify


Marital Status

Single

Married

Gender

Male

Female

Passport Number

Divorced

Place of Issue

Separated

Widowed

Religion

Date of Issue

Date of Expiry

Have you ever been convicted of a criminal offence?

Yes

No

Have you ever required medical treatment or counseling for drug or alcohol abuse?

Yes

No

Have you any pre-existing medical condition / illness?

Yes

No

Do you suffer from any physical defect or partial disability?

Yes

No

Yes

No

If Yes, please give details

If Yes, please give details

Do you have any relatives employed by D2D or any of its subsidiaries?


If Yes, please give details

Name

First

Relationship

Emergency contact details


Address

Name

First

Middle
Designation

Middle
Relationship

Family / Surname

Family / Surname

Residence Tel.
Mobile Tel.
Page 2

a) Glasses ?

Yes

No

b) Contact Lenses?

Yes

No

Do you suffer from colour blindness ?

Yes

No

Do you smoke ?

Yes

No

Have you ever worked irregular hours?

Yes

No

Are you prepared to do shift work?

Yes

No

Do you hold a valid driving license ?

Yes

No

Do you wear

If yes, please give details

If yes, please give details

Long sighted / Short sighted / other :

Issued in

Valid until

Education & Qualifications


Dates
Qualifications Achieved

From
MM

YY

To
MM

YY

School / College
( Highest Qualification )

University / Other

Business / Professional

Other

Please indicate competency in languages [ B = basic I = intermediate F = fluent ]


Language

Read

Write

Speak

Language

Read

Write

Speak

Page 3

Employment History ( Start with your current / last employer )


Dates
Name and City of Employer

From
MM

Reason for leaving last position

Notice Period from current position

Expected Gross Annual Salary Package

YY

To
MM

Position held
YY

Gross Annual
Salary
Package

Details of most recent compensation

Per Month
Basic Salary
HRA
Conveyance Allowance
Special Allowance
Other Allowances

Total - A
Per Annum
Leave Travel Allowance
Medicals
Bonus
Performance Related Pay
Provident Fund
Supperannuation
Others

Total - B
Perquisites
Car
House
Others
Gross Pay Per Annum / CTC

Page 4

References

Please give at least 2 business and 1 personal references ( NOT family members/ Relatives )
1

Name
Address

Position or Title
Telephone

Fax

Email Address
2

Name
Address

Position or Title
Telephone

Fax

Email Address
3

Name
Address

Position or Title
Telephone

Fax

Email Address
Family Details
No.

Name

Relationship

Date of Birth
DD

MM

YY

Passport Number

Spouse
1
Parents
1
2
Parents in Law
1
2
Brothers / Sisters
1
2
3
4

No.

Name

Custody
( Yes / No )

Relationship

Date of Birth
DD

MM

YY

Passport Number

Children
1
2
3
4

Page 5

Are you a member of any Professional Association / Club / Society ?

Yes

No

If Yes, please give details

Please list any interest in sports and/or other hobbies ?

Briefly state why you wish to join D2D or any of its subsidiaries?

Declaration
I hereby declare that the information given is correct to the best of my knowledge and belief, and that I have
not withheld any information which might reasonably be calculated to adversely affect my suitability for
employment.

Dated

Signed :

Page 6

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