Strictly Private & Confidential

Application for Appointment

GE INDIA (GE) DOES NOT DISCRIMINATE IN EMPLOYMENT ON THE BASIS OF AGE, RACE, COLOUR, RELIGION, GENDER, NATIONAL ORIGIN, ANCESTRY, DISABILITY, VETERAN STATUS, MARITAL STATUS, SEXUAL ORIENTATION, CITIZENSHIP STATUS OR ANY OTHER PROTECTED

THE PRE AND POST BACKGROUND CHECKS WILL INCLUDE VERIFICATION OF THE INFORMATION GIVEN ON THIS EMPLOYMENT APPLICATION, SO IT IS IMPORTANT THAT THE INFORMATION BE COMPLETE AND ACCURATE If any question is not relevant to you, please write N/A for Not Applicable. Use additional pages if necessary.
As it appears on your birth certificate or passport please print your legal name: Surname (Dr., Mr., Ms, Mrs.): BLOCK LETTERS Middle: (use BLACK ink or typescript only) First:

Address: (number/street): BLOCK LETTERS Home telephone: ( ) Mobile number: ( )

City: May we contact at business? Yes No E-mail address:

Country: Business telephone: ( )

Postal/Zip Code:

Date of Birth (dd/mm/yyyy) Passport No.

Fathers Name Date and Place of Issue.

Nationality Date of Expiry

Do you have the legal right to reside and work in India ?

Yes

No

Are there any restrictions or limitations on your right to employment in India If yes, please explain:

Yes

No

List in full all former home addresses you have resided at within the past five years.
Dates: (From - to) (mm/yy) Address (Number and street) City Country Postal/Zip Code

Position applied for: Are you related to an employee at GE and/or any of its subsidiaries or affiliates (Company)? If yes, state name of relative: Have you ever been employed by the Company? If yes, from (mm/yyyy): to (mm/yyyy): Department: Relationship to you:

Yes

No

Yes

No

Have you previously filed an application with or been interviewed by anyone within the Company? If yes, when (month/yr) and by whom: How were you referred? Own accord:

Yes

No

School: Other (Please describe):

Agency (name): Advertisement (name of publication):

EDUCATION:

Starting with school most recently attended, list in date order all periods of education. Include all high schools; vocational/technical schools; junior colleges; military schools; colleges; graduate schools; and equivalency diplomas. From (mm/yyyy): Name of School (University and College) Type of degree, certificate, diploma: To (mm/yyyy): Graduated: Yes No From (mm/yyyy): To (mm/yyyy): Graduated: Yes No From (mm/yyyy): To (mm/yyyy): Graduated: Yes No From (mm/yyyy): To (mm/yyyy): Graduated: Yes No Address: Expected graduation date (mm/yyyy) City/State: Session Attended: Day Evening/Weekend No. of credits completed: Country: Major (also mention Exam Seat No.)

Name of School: (University and College) Address: Expected graduation date (mm/yyyy)

Type of degree, certificate, diploma: City/State: Country: No. of credits completed: Major: (also mention Exam Seat No.)

Session Attended: Day Evening/Weekend

Name of School: (University and College) Address: Expected graduation date (mm/yyyy)

Type of degree, certificate, diploma: City/State: Country: No. of credits completed: Major: (also mention Exam Seat No.)

Session Attended: Day Evening/Weekend

Name of School: (University and College) Address: Expected graduation date (mm/yyyy)

Type of degree, certificate, diploma: City/State: Country: No. of credits completed: Major: (also mention Exam Seat No.)

Session Attended: Day Evening/Weekend

EMPLOYMENT HISTORY:

Starting with you present or most recent employer, please list all dates of employment with your previous 6 employers. Include military service, temporary, part-time and summer work. For compensation sections, specify currency and basis for salary (i.e. monthly or yearly). When listing consulting or temporary assignments, under Employer, state the name of the consulting or temporary agency that placed you at the client site. Complete and accurate dates (month/year) must be provided. YOU WILL BE REQUESTED TO PROVIDE VERIFICATION OF SALARY AND OTHER COMPENSATION THROUGH WAGE OR TAX STATEMENTS AND/OR PAYROLL RECEIPTS. Employer: Assignment type: From To (month/yr): Supervisors Name and (month/yr): Telephone no. Part-Time

Full-Time
Address: Telephone and Fax ( ) Starting base salary: (indicate currency) $ Employer: City/State: Position(s): Other compensation: $ Total: $ Country: HR Managers name: Reason for leaving: Final base salary: $ Assignment type: Part-Time From (month/yr): Other compensation: $ To (month/yr): Total: $ Supervisors Name and Telephone no. HR Managers Phone No.

Address: Telephone: and Fax ( ) Starting base salary: (indicate currency) $ Employer: City/State: Position(s): Other compensation: $ Total: $ Country:

Full-Time HR Managers name: Reason for leaving: Final base salary: $ Other compensation: $ From (month/yr): To (month/yr): Total: $ Supervisors Name and Telephone no. HR Managers Phone No.

Assignment type: Part-Time

Address: Telephone: and Fax ( ) Starting base salary: (indicate currency) $ Employer: City/State: Position(s): Other compensation: $ Total: $ Country:

Full-Time HR Managers name: Reason for leaving: Final base salary: $ Other compensation: $ From (month/yr): To (month/yr): Total: $ Supervisors Name and Telephone no. HR Managers Phone No.

Assignment type: Part-Time

Address: Telephone: and Fax ( ) Starting base salary: (indicate currency) $ City/State: Position(s): Other compensation: $ Total: $ Country:

Full-Time HR Managers name: Reason for leaving: Final base salary: $ Other compensation: $ Total: $ HR Managers Phone No.

EMPLOYMENT HISTORY CONTINUED:

Employer: Assignment type: Part-Time From (month/yr): To (month/yr): Supervisors Name and Telephone no.

Address: Telephone and Fax: ( ) Starting base salary: (indicate currency) $ City/State: Position(s): Other compensation: $ Total: $ Country:

Full-Time HR Managers name: Reason for leaving: Final base salary: $ Other compensation: $ Total: $ HR Managers Phone No.

UNEMPLOYMENT: Account for all gaps of one month or more in your employment, other than school
From (mm/yyyy) To (mm/yyyy) Reason

JOB RELATED ACTIVITIES AND ACHIEVEMENTS:

Please list any special or significant training or professional certification(s) relevant to the assignment for which you have applied. You may exclude the name of any organisation that would indicate race, religion, national origin or any other protected group.

LANGUAGE PROFICIENCES: For each language please indicate whether you have full proficiency (reading, writing and speaking ability) or limited proficiency. Language: Speak Read Write

REFEREES:
Please give details of 3 references, one of whom should be academic (BLOCK LETTERS)

Reference 1 Name Organisation Position Address Telephone Relationship

Reference 2

Reference 3

ADDITIONAL INFORMATION:
Do you now have any debts or accounts (including mortgages, loans, student loans, credit cards, charge accounts, etc.) Yes No. If Yes, please describe by listing for each debt its amount, the type of debt, and to whom it is owed:

Do you now have any past due accounts, or have any of your creditors (e.g. banks, department stores, etc.) ever obtained a judgment against you or incurred a

charge off or loss due to your non-payment? Yes No. If Yes, include all terms in collection as well as tax liens and civil judgments, and please describe all background details:

Note: Yes will not necessarily disqualify you from employment. Are you currently or do you expect to be engaged in any occupation or business activity as an employee, director, officer, shareholder, executor, trustee, nominee etc., which you would want to continue if accepted for employment? Yes No. If Yes, please describe:

1)

Have you ever been convicted of, pleaded guilty to, or entered a plea of no contest or similar plea to any criminal offence, in a domestic or foreign court including in a military court?

Yes No 2)
At this time, do you have any arrest or criminal accusation pending against you? Yes No. For any yes answer, please state here the name and location of the court, the date and nature of the offence, the disposition (if any) of your case, and any other relevant information you wish to have considered.

Use additional pages if necessary. Please note that a conviction will not necessarily disqualify you from employment. The information you provide here, among other factors and statutory restrictions, will be considered in making a decision regarding employment. Please read the following statements carefully. You will be considered for employment only after you complete and sign the application. 1. The information I have provided on this application is accurate to the best of my knowledge, and subject to verification by GE. I understand that any untrue statement or misrepresentation of fact in my application materials will be justification for dismissal. 2. I understand that any offer of employment by GE is conditional upon the satisfactory completion of all regulatory checks and independent reference, security, and consumer reports, which may include information as to my work history, character and general reputation. I hereby authorize such reports. I understand that I will be required to complete a separate disclosure and authorization statement that authorizes any consumer or investigation reports to be sought on me in connection with my employment. 3. I understand that if employed, I am required to abide by all rules, regulations, and policies of GE. 4. I understand that the use of this application does not indicate that there are any positions open and does not in any way obligate the GE to offer me employment. 5. If employed, I understand that, subject to applicable law, my employment will be terminated-at-will. This means that there is no express or implied obligation or contractual right for GE to maintain me in its employ indefinitely or for any specified period of time. In consideration of my employment, I agree to conform to the firms rules and policies and that GE is entitled, at its option and without notice, to change or terminate my employment or terms and conditions thereof.

Signature:

Date:

Name:

Information Release Form

To Whom It May Concern:
PLEASE PRINT

I_______________________________________________________________________
LAST NAME FIRST NAME MIDDLE NAME

hereby authorise GE India and/or any of its subsidiaries or affiliates (GE), and any persons or organisations acting on its behalf, namely Hill & Associates Limited, to verify information presented on my employment application/resume and to procure an investigative report or consumer report for that purpose. I hereby grant authority for the bearer of this letter to access or be provided with full details of my previous employment record held by any company or business for whom I previously worked. This information should include the dates of employment; the nature of the position held, [details of my salary upon departure] and an appraisal of my performance, capabilities and character. In addition, please provide any other pertinent information requested by the individual presenting this authority. I hereby release from liability all persons or entities requesting or supplying such information.

Signature: Have you ever been known by another name? If yes, state name(s)

Date:

/ / dd mm yyyy

YES

NO

SCREENING TASK SHEET[ TO BE FIILED BY THE HRM BEFORE SENDING TO HILL]

ASSIGNEE Contact Manager Business Unit ASSIGNMENT Reference Number Subject Name Date of Birth Date of Assignment Checks Required

Level 1 Criminal Check DOCUMENTS ATTACHED

Level II

Other Documents

Information Release Form Curriculum Vitae/Bio Data Application for Appointment

Contact Current Employer Comments (if any)

Yes No

FOR OFFICE USE Date Received Due Date Contact Manager

Location