Candidate Declaration Form – HCL Tech

Instructions: Please provide all the information requested in this form. Incomplete Candidate
Declaration Forms (CDFs) will be returned. All supporting documents must accompany this
form. Photocopies must be legible. We have included a checklist to assist you to complete your
application comprehensively. (Please fill in the information in Capital Letters)

Candidate Reference No: (To be entered by Official personnel only)

PERSONAL DETAILS

Full Name (First/Middle/Last): MADASANI VYSHNAVI

Fathers Name:
MADASANI SAMBASIVA RAO

Date of Birth (DD/MM/YYYY):10/04/2000 Personal Number: 9014102027 Nationality:INDIAN

Passport Number: Date of Issue: Date of Expiry:

Social Security / PAN Number (If worked/studied in the US/Any other Country) CDTPV9271N

Change of Name if Applicable

Former Name/Maiden Name

Date of Name Change

Current Address Permanent Address

Door No/Street: 65-18-1708/1 GOLUSUKONDALA RAO Door No/Street: 65-18-1708/1 GOLOSUKONDALA RAO
NAGAR 1ST LANE OLD GUNTUR GUNTUR NAGAR 1ST LANE OLD GUNTUR GUNTUR

City: GUNTUR City: GUNTUR

State: ANDHRA PRADESH State: ANDHRA PRADESH

Pin: 522001 Pin: 522001

Period Of Stay 2010 to TILL Period Of Stay 2010 to TILL

Landmark: RAINBOW SCHOOL Landmark: RAINBOW SCHOOL

: (Landline) 7330616027 (Landline)

Is your residence your own or a rented place? OWN Note - Please attach 1 address proof each for your
If rented, please provide details of the Landlord
Name: Current & permanent address.
Address:
(Tear away slip) For Internal Use Only
City:

State:
Pin:
(Landline)
 EDUCATION DETAILS:

Education 1 (Course Completed) – Highest Degree

ST MARYS GROUP OF INSTITUTION GUNTUR
Name of the Institute

Name of University JNTUK

Affiliated with
18BJ1A0545 Duration of Course (Yrs.) 2018 JULY TO 2022
Student ID No./ From…………………… APRIL
Enrolment No./ (Month and the Year)
Seat No./ To……………………….
(Month and the Year)
FIRST CLASS YES
Division Class Degree Obtained

COMPUTER SCIENCE AND Course Type FULL TIME

Subject Major ENGINEERING (Full Time /
Correspondence)
Address of Institution CHEBROLE GUNTUR
(Only fill in the details asked City
for to the right)
ANDHRA PRADESH 522212
State Pin Code

08644- 212525 08644- 212525

(Landline) 1 (Landline) 2

Note: Please attach legible copies of the following documents relevant to your entries in the form. (Xerox
only)

1. Educational Mark Sheets / Certificates – Attach the documents relevant to your entry above.
a. SSC / Global Equivalent.
b. HSC / Global Equivalent.
c. Graduation all year mark sheets & degree certificate or provisional certificate.
 EMPLOYMENT DETAILS
NOTE: There are two categories in each form. Please provide information under the relevant Employment Category.
LAST EMPLOYMENT
Name of Company
 Registered Corporate  Branch Office
Where were you employed?
Office
Door No/Street:

Company Address
(Where you were employed ) City State

Pin (Landline)

Period of Employment
Employee Code
(From … To …)
Remuneration
Designation
(CTC Per Annum)
Department Reported to
Supervisor’s Designation
(Email Id)

CONTRACTUAL EMPLOYMENT
Company Name

Company Address
Door No. / Street

State
City

Company Contact Person

(Email Id)

Designation (Landline)

State your Reason for Leaving

Note: Please attach legible photocopies of the following documents relevant to the entries above
1) Appointment Letter 2) Salary Slip 3) Release Letter
 PREVIOUS EMPLOYMENT - 2
Name of Company
 Registered Corporate  Branch Office
Where were you employed? Office
Door No/Street:

Company Address
(Where you were employed ) City State

Pin (Landline)

Period of Employment
Employee Code
(From … To …)
Remuneration
Designation
(CTC Per Annum)
Department Reported to
Supervisor’s Designation
(Email Id)

CONTRACTUAL EMPLOYMENT
Company Name

Company Address
Door No. / Street

State
City

Company Contact Person

(Email Id)

Designation (Landline)

State your Reason for leaving

Note: Please attach legible photocopies of the following documents relevant to the entries above
1) Appointment Letter 2) Salary Slip 3) Release Letter
 PREVIOUS EMPLOYMENT - 3
Name of Company
 Registered Corporate  Branch Office
Where were you employed? Office
Door No/Street:

Company Address
(Where you were employed ) City State

Pin (Landline)

Period of Employment
Employee Code
(From … To …)
Remuneration
Designation
(CTC Per Annum)
Department Reported to
Supervisor’s Designation
(Email Id)

CONTRACTUAL EMPLOYMENT
Company Name

Company Address
Door No. / Street

State
City

Company Contact Person

(Email Id)

Designation (Landline)

State your Reason for leaving

Note: Please attach legible photocopies of the following documents relevant to the entries above
1) Appointment Letter 2) Salary Slip 3) Release Letter
Reference Check:
Reference
Reference Reference Reference Contact Numbers Reference Official
Full Name Company Name Designation (Office and Email Id
Mobile)
 Authorization/ Declaration and Undertaking

If Employed with HCL TECH I agree to provide copies of all relevant certificates.

I understand that employment with HCL TECH is governed by their employment policies as applicable, includingsatisfactory
information from background check.

I hereby certify that all information provided herein, is true and complete to the best of my knowledge and belief. I authorize
HCL TECH and its representative to authenticate information I have provided in my resume and this Candidate Declaration
Form (CDF). To conduct enquiries as may be necessary at the company’s discretion, I authorize all who may have
information relevant to this enquiry to disclose it to HCL TECH and / or its representative. I release all concerned from any
liability on account of such disclosures.

I also declare that the information provided by me in my resume and application for employment to
HCL TECH and its representative is authentic and I am liable for all inaccuracies and omissions.

I promise to extend total co-operation and provide relevant documents required.

Note: Any information found to be incorrect during Background Verification, a necessary action will be taken
by the company as per the Law which would be imprisonment / debarring from future employments.

Full Name of the Candidate: MADASANI VYSHNAVI Signature of the Candidate

Place : Guntur

Date: 27.04.2024
 Checklist for Candidates

Note: This checklist is to assist you. Please go through all the columns.

Personal Details Addresses

Current Address Permanent Address
Fathers’ Name Yes No Pin Code Yes No Pin Code Yes No
Your Date of Birth Yes No Landmark Yes No Landmark Yes No
Your Passport
Yes NA Landline No Yes No Landline No Yes No
Details
Mobile number Yes No NA Landlords Name Yes No Neighbours, Name Yes No
Social Security
Number Yes No NA Landlords No Yes No Neighbours, No Yes No
/ Other Country Nos.
Personal Contact Last Electricity
Yes No NA Yes No Last Electricity Bill Yes No
No. Bill
Date of Name
Yes No NA Last Phone bill Yes No Last Phone bill Yes No
Change
Education
High School Higher Secondary Graduation Post Graduation
Student Id/Enrolment
Yes No NA Yes No NA Yes No NA Yes No NA
No.
School/College Name Yes No NA Yes No NA Yes No NA Yes No NA
Location Yes No NA Yes No NA Yes No NA Yes No NA
University/ Institution
Yes No NA Yes No NA Yes No NA Yes No NA
Name
Mark sheets Yes No NA Yes No NA Yes No NA Yes No NA
Provisional Certificates Yes No NA Yes No NA Yes No NA Yes No NA
Degree Certificates Yes No NA Yes No NA Yes No NA Yes No NA
Yes No NA Yes No NA Yes No NA Yes No NA

Employment
Employment 1 Employment 2
Name of Company Yes No NA Yes No NA
Location Yes No NA Yes No NA
Company Contact Nos. Yes No NA Yes No NA
Employee Code Yes No NA Yes No NA
Period of Employment Yes No NA Yes No NA
Appointment Letter Yes No NA Yes No NA
Relieving Letter Yes No NA Yes No NA
Accurate Remuneration Yes No NA Yes No NA
Person Reporting to/Name/ No Yes No NA Yes No NA

Authorization
Name Yes No
Place Yes No
Date Yes No
Signature Yes No