EMPLOYMENT FORM

APPLICANT No.
Location: Stick 1 Photograph here
Department:
POSITION APPLIED ………………………………………...
FOR:
POSITION

NAME IN FULL
(in block letters)
First Middle Surname
Date of Birth (DD/MM/YYYY) & Age:
SEX: (M/F)______________ Height: Weight:

PERMANENT ADDRESS: Temporary Address:

PERSONAL DETAILS

Mobile No.: 1) 2)

Telephone No.:
e-mail:(Personal)

PLACE OF BIRTH : DOMICILE OF (STATE OF INDIA) :

CITY:

COUNTRY:

CITIZENSHIP(S):

RELATIONSHIP DOB NAME ADDRESS

FATHER
FAMILY DETAILS

MOTHER

SPOUSE

KID - 1

KID - 2

KID - 3

MARITAL STATUS [Single/Married] : Date of Marriage :

ALLERGIES, IF ANY :
BLOOD GROUP :
HEALTH

Vision LAST MAJOR ILLNESS SURGERY:

LEFT: Right: (Specify date)
In order to accommodate employee special needs in the work environment. Please indicate if you are physically challenged(Y/N):
If yes please provide description of disability & accommodation required :

EDUCATIONAL & PROFESSIONAL QUALIFICATIONS (STATE HIGHEST QUALIFICATION FIRST)

(Please complete all fields. Even if you have already provide resume, please provide details on completed degree programs only)
UNIVERSITY / BOARD START END
DEGREE % or Marks MAIN SUBJECTS CGPA*
COLLEGE/INSTITUTE DATE DATE

DOCTORATE
QUALIFICATION

POST
GRADUATION

GRADUATION

Diploma

HSC

SSC
* PAN [Permanent Account Number]: Aadhar:

PLEASE WRITE 'NA' IF NOT APPLICABLE

Specify clearly in case of part time/contract work experience . Notice period required
PERIOD (MM/YYYY)
ORGANISATION WITH
DURATION DESIGNATIO MAJOR RESPONSIBILITIES
LOCATION(Current Org. First) FROM TO
(in months) N
WORK EXPERIENCE

LIST OF TWO PROFESSIONAL REFERENCES :

SR.NO NAME OCCUPATION E-MAIL Mobile No.

DO YOU KNOW ANYONE WORKING AT SERUM INSTITUTE PRESENTLY?(Yes/No):

If yes, Mention the details below.

SR.NO NAME RELATIONSHIP Department & DESIGNATION

1
REFERENCES

DO YOU HAVE ANY RELATIVE WORKING AT SERUM INSTITUTE PRESENTLY?(Yes/No):

If yes, Mention the details below.

SR.NO NAME RELATIONSHIP Department & DESIGNATION

CONTACT PERSON IN CASE OF EMERGENCY :

SR.NO NAME TEL.NO./ MOBILE RELATIONSHIP

2
 Organisation Chart
COMPENSATION PM PA

Basic Your immediate Superior

HRA

Dearness Allowance

Conveyance Allowance/
Reimbursement

Professional Journals Your position

Educational Allowance

Other Monthly Allowance

COMPENSATION

SUB TOTAL (A)

2. ANNUAL
LTA

Medical Reimbursement
Bonus/Ex-gratia

Other Annual Benefits

SUB TOTAL (B)

3. RETIREMENT BENEFITS
Provident Fund

Gratuity Subordinates

Superannuation

SUB TOTAL 'C'

GRAND TOTAL (A+B+C)

LOANS : Amount Eligible

BENEFITS

Housing

4 wheeler

Other

SALARY EXPECTED (CTC per annum) :

HAVE YOU APPLIED TO SERUM INSTITUTE PREVIOUSLY?(Yes/No):

IF YES,

WERE YOU CALLED FOR A TEST?

WERE YOU SHORTLISTED FOR AN INTERVIEW?

WERE YOU MADE AN OFFER?

IF ANY OTHER REASON

Have you been employed by Poonawalla Group? (Yes/No):

If Yes, please provide following details :

Tenure (DD/MM/YY)
Business Unit Location Reporting to Employment status Employee No
Start Date End Date
MISCELLANEOUS

ARE YOU EMPLOYED AS :

A. A DIRECTOR IN ANY OTHER COMPANY?(Yes/No):

B. A PARTNER IN ANY FORM?(Yes/No):

IF YES, PLEASE MENTION DETAILS OF THE SAME:

ARE YOU A MEMBER OF ANY POLITICAL PARTY?(Yes/No):

IF YES, PLEASE GIVE DETAILS :

LIST OF THREE OF YOUR MAJOR STRENGTHS AND WEAKNESS

STRENGTHS WEAKNESSES
 LIST YOUR MAJOR ACHIEVEMENTS

ARE YOU UNDER ANY LEGAL OBLIGATION TO YOUR CURRENT EMPLOYER?(Yes/No)

IF YES, PLEASE CLARIFY :
MISCELLANEOUS

ANY OTHER INFOMRATION YOU MAY WISH TO PROVIDE IN SUPPORT OF YOUR CANDIDATURE :

Have you at any time been convicted by a court of India for any criminal offence and sentenced to imprisonment, or any criminal proceedings are pending against you
before a court of India, or any order prohibiting your departure from India has been issued by a court? (Yes/No):
If yes, please give details of the same.

NOTICE PERIOD FOR JOINING :

I certify that the above information given by me in this Employement Form is true, complete and correct.
All the Acadamic Marks/ Percentage/ CGPA are correct. Also the salary structure and all other information provided in this form
is correct and updated.I agree that in case the company finds any time during my employement that the information given by me
in this Employement form is incorrect, false or incomplete, the company will have the right to withdraw my letter of appointment
or terminate my appoitment at any time without any notice or compensation.
I Authorise company to verify information given in this form at any time during my employement by any external agency

to refference check with my past Employer, college , school, without my consent.

Place : Signature of Candidature

Date :
Candidature Name
FOR OFFICIAL USE ONLY
VACANCY NO.: Requisition By Source :
NEW/ REPLACEMENT Replacement of : Employee Status : Trainee / Probation