( PLEASE STAPLE A

RECENT PASSPORT
SIZED PHOTOGRAPH )

EMPLOYEE APPLICATION / JOINING 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 :

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Personal Details

Date of Birth Place of Birth City

D D M M Y Y Country

Nationality at Birth Height

Nationality at Present [ In Cms. ]

Do you hold Dual Nationality? Yes No Weight

If Yes, please specify [ In Kgs. ]

Marital Status Single Married Divorced Separated Widowed

Gender Male Female Religion

Passport Number Place of Issue 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

If Yes, please give details

Have you any pre-existing medical condition / illness? Yes No

Do you suffer from any physical defect or partial disability? Yes No

If Yes, please give details

Do you have any relatives employed Yes No

If Yes, please give details

Name
First Middle Family / Surname
Relationship Designation

Emergency contact details Name

First Middle Family / Surname
Address Relationship
Residence Tel.
Mobile Tel.

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 Do you wear a) Glasses ? Yes No

b) Contact Lenses? Yes No

If yes, please give details Long sighted / Short sighted / other :

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

If yes, please give details Issued in Valid until

Education & Qualifications

Dates
Qualifications Achieved From To
MM YY 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

E Page 3
Employment History ( Start with your current / last employer )

Dates Gross Annual

Name and City of Employer From To Position held Salary
MM YY MM YY Package

Reason for leaving last position :

Notice Period from current position :

Expected 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

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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

Date of Birth
No. Name Relationship Passport Number
DD MM YY
Spouse
1
Parents
1
2
Parents in Law
1
2
Brothers / Sisters
1
2
3
4

Custody Date of Birth

No. Name Relationship Passport Number
( Yes / No ) DD MM YY
Children
1
2
3
4

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 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 CEMAC Group 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.

I authorize CEMAC Group to verify my medical records and obtain references as necessary on the
understanding that Taj will not contact my current employer until I am offered employment or I have given
specific authority in writing to obtain such references.

Dated : Signed :

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