TCS EMPLOYMENT APPLICATION FORM

BASIC DETAILS
Reference # DT20234685471

PERSONAL DETAILS
College/Institute Bundelkhand Institute Of Engineering and
Technology, Jhansi
Name Mr. Shivam Kumar Pathak
Father's Name Mr.Pawan Kumar Pathak
Date Of Birth 21/08/2004
Nationality India
Gender Male
SSC Roll Number

CONTACT DETAILS
PERMANENT ADDRESS
House No./Apartment Name/Block No Village - Gauri Pathak
Road/Street/Lane Bansi- Dumariyaganj Road
Area/Landmark Khoriya Chauraha
City Bansi
State Uttar Pradesh
PIN Code 272153
Country India

PRESENT ADDRESS
House No./Apartment Name/Block No Atal Bihari Vajpayee Hostel
Road/Street/Lane Biet Jhansi
Area/Landmark Biet Jhansi
City Jhansi
State Uttar Pradesh
PIN Code 284128
Country India
ACADEMIC DETAILS:
Degree Course Duration Duration Course University/Institute Board Of Specialization CGPA/Marks Total Percentage
Name From To Type Education Obtained Marks/CGPA
Graduate Bachelor 15/11/2021 31/05/2025 Full Time Bundelkhand Institute Computer 7.3 10.0 73.01
Of Of Engineering And Science And
Technolog Technology, Jhansi Engineering
y
XII 01/04/2020 31/07/2021 Full Time Adarsh Intermediate State Board Pcm 425.0 500.0 85.0
College
X 01/04/2018 06/05/2019 Full Time Siddharth Public CBSE 468.0 500.0 93.6
School
Are there any break in studies ? No
Rewards Or Scholarships : I Was An Ffe (Foundation For Excellence) Scholar During My Graduation.
Academic Projects Undertaken: Study Notion
Built A Full-Stack Edtech Platform For Course Creation, Sales, And Student Enrollment, With Integrated Payments Etc. Using
Mern Stack.
Have you done any other course ? No
Do you have any pending backlogs No
currently ?
Declaration
1. You have taken all subject marks into consideration for calculating the obtained/Total Marks/CGPA in each
of the above mentioned academic qualifications :
Yes
2. The "Marks/CGPA Obtained" entered by you for each of the above mentioned academic qualifications has
been secured in the first attempt :
Yes
3. You have considered only the Marks/CGPA obtained during the normal duration of the course for calculating
Obtained/Total Marks/CGPA :
Yes
4. You have completed each of the above mentioned academic courses in the stipulated time as specified by
your University/Institute and as per TCSL selection guidelines and do not have any extended education:
Yes
5. You have declared break in studies/work experience and pending backlogs,if any, during your academics:
Yes
6. You have not attended the TCSL Selection Process in the last 6 months:
Yes
7. You have read the TCSL eligibility criteria and understand that your candidature/application/offer/ on
boarding is subject to fulfillment of the specified criteria :
Yes
I Mr. Shivam Kumar Pathak solemnly declare that the information in this form is truly stated and correct and I am competent
to furnish as well as verify it with adequate details whenever requested for by TCSL.
CONTACT DETAILS
E-mail ID shivampathak0123456@gmail.com
Mobile Number 91 - 9569729522
Alternate E-Mail ID sujeetpathak609@gmail.com
Alternate Contact Number 91 - 9984609407

LANGUAGE DETAILS:

Language Mother Tongue Read Speak Write

Hindi Yes Yes Yes Yes

English No Yes Yes Yes

TCS RELATED DETAILS:

Have you appeared for TCS Test / Interviews earlier? No

Security Details

Are you involved in any pending and / or closed Civil / Criminal / case / proceedings / charges / enquiry prior to joining No

TCS.

Are you involved in any pending and / or closed Disciplinary / malpractices and / or any other charges / proceedings / No

enquiry / case pending against me in any University or any other educational authority / institution prior to joining TCS.

''If the answer to any of the above mentioned question is YES give full particulars of the case / arrest /detention / fine
/conviction / sentence / punishment etc. and / or the nature of the case pending in the Court / University / Educational
authority etc. at the time of filling this form.''
TCS Terms and Conditions

In connection with my application to render services to Tata Consultancy Services Ltd (the "Company"), I hereby agree as
follows:I certify that the information furnished in this form as well as in all other forms filled-in by me in conjunction with my
traineeship is factually correct and subject to verification by TCS including Reference Check and Background Verification. I
accept that an appointment given to me on this basis can be revoked and/ or terminated without any notice at any time in
future if any information has been found to be false, misleading, deliberately omitted/suppressed. As a condition of
Company's consideration of my application for traineeship with the Company, I hereby give my consent to the Company to
investigate or cause to be investigated through any third parties my personal, educational and pre or post joining history. I
understand that the background investigation will include, but not be limited to, verification of all information given by me to
the Company. I confirm that the Company is entitled to share such investigation report with its clients to the extent necessary
in connection with the Services, which I may be required to provide to such clients. I confirm and undertake that the
Company shall incur no liability or obligation of any nature whatsoever resulting from such investigation or sharing of the
investigation results as above. I certify that I am at present in sound mental and physical condition to undertake employment
with TCS. I also declare that there is no criminal case filed against me or pending against me in any Court of law in India or
abroad and no restrictions are placed on my travelling anywhere in India or abroad for the purpose of business of the
Company.

Your Electronic Signature is:

Name:Mr. Shivam Kumar Pathak

Date:21/03/2025

Place:Jhansi

TCS is an equal opportunity employer that aims to integrate global diversity and inclusion at each level within our
organization. Hiring decisions are solely made on the capability of an individual to perform a role. Any personal details like
gender, age and nationality that may be provided by you during the course of application or selection process will be used for
administrative records and all qualified applicants will receive consideration for employment without regard to this
information.