HUMAN RESOURCES DEVELOPMENT DEPARTMENT A.O.
KARUR
Application cum Bio-data for the post of __________________
01. Name & Address of the Applicant
:
Passport size photo
02. Nationality Religion
Caste
FC
BC
SC
ST
Others
03. Native
Place with taluk
District
State
04. Date of Birth & Age 05. Marital Status 06. Mother tongue
:
:Married/Unmarried/Widower/Widow/Divorcee
: Regular / Evening / Correspondence
07. Academic / Professional qualifications: Degree Major Class Month & Year Name of the Subject / Div of Passing university / Institute
b). Technical Qualification Typewriting Sl. No 01 02 03 C). Computer qualification:
Degree Month & year of passing
: Short Hand Month & Year of passing Sl. No 01 02 03 Language Grade Month & Year of passing
Language
Grade
Name of University
Regular / Evening / Distance
Diploma / certificate course
Month & year of passing
Duration
Name of University / institution
Regular / Evening / Distance
08. Employment Data Name of the organization
: Position Held
Period
Responsibilities
Place of work
Present
Employer Designation Scale Salary Place of work
: : : : :
09 . Languages Known: S. No Languages Read Write Speak
10. Financial status of the family-immovable assets
Nature Location Approximate Value Rs. Ancestral/acquired by father /self acquired Encumbrance, if any Income, if any Rs.
Land/site Building House/Flat 11. Other assets (value in Rs.) Cash on Hand Cash at Bank Jewels Investments Others, if any specify
12.
Is there any other source of : income to the applicant? (Please specify)
13.
Is the applicant engaged in any : business or has interest in any firm? If so, mention the nature of business and the name of the firm Family Background : (As per the specimen enclosed)
14.
15.
a) Have you undergone any : prolonged treatment for any of the following disorders Kind of Disorder Cardiac Kidney Pulmonary Others, if any b) Have you undergone any : surgery If so, give details of surgery, date and Hospital : c) Blood Group : Yes No
16.
Are you prepared to appear for a : detailed medical examination by our Medical panel? Do you have any objection over : the Banks right to enquire about your antecedents? Loans, if any outstanding in your : present organization Do you want us to take over the : loans availed from your present employer? Whether any Disciplinary : Proceedings have been initiated against you / are pending against you / are being contemplated against you? Whether any case has been : registered against you / being initiated against you / is contemplated against you by any agencies like Police, CBI, etc.?
17.
18. 19.
20.
21.
22.
Whether any investigation civil / : criminal of nature is pending against you / is being contemplated against You? Any cases filed by you in a court or : dispute raised by you against Employer / Bank Whether any relative is working in : our Bank? a) Time required for joining from : the date of receipt of appointment order b) Present Salary :BP : Perks : Allowance:
23.
24. 25.
26. 27. 28. 29.
Are you willing to consider any : other position, if offered? If selected, are you willing to work : at Karur? Whether willing to serve anywhere : in India? Are you willing to consider : positions as part time or contract basis Two references for verification : (Name and address with Phone Number)
30.
31.
Have you gone abroad? If so, give : details.
32.
a) Are you a member / Office : bearer of any service club, specify b) Hobbies/Past interest time/other :
33.
Address for communications with : contact Phone/Fax/E Mail Number
DECLARATION I, ___________________________, S/o-D/o-W/o _____________________ hereby certify that the information given above are true to the best of my knowledge. I further declare that if any of the information given by me found to be false / misrepresented, my appointment is liable to be terminated / cancelled without notice.
Place: Date : SIGNATURE
ANNEXURE: FAMILY BACKGROUND:
Sl. No Name (Sarvashree) Age Marital Status Educational qualifications Occupation / Nature of employment Name of the Exemployer Annual Income If retired monthly pension drawn
01. 02. 03
Father Mother Brother/s
04
Sister/s
05.
If you are married then give wifes /Husbands name Son/s / Daugher/s
06.
Place: Date:
SIGNATURE OF THE APPLICANT
