Document No.

: F/HRD/21
Revision No. : 02
POLY MEDICURE LIMITED
Page No. : 01 of 02
APPLICANT DATA FORM

Date of Interview : __________________ Designation Applied for : __________ Dept. applied for : __________

Name of Candidate :________________ Date of Birth : ________________ Religion : ________________

Contact No. ________________________ E-mail ID : ________________________________________________

Do you have any relatives in (Company) ? No/Yes , if Yes, Name of Relatives : _______________________

Designation : _______________________

Have you ever Interviewed with Polymedicure? No/Yes, if Yes, Date of Interview : ________________

Interview for the Position: ___________________

ADDRESS :

Present Address Permanent Home Address

Telephone No. Telephone No.

Email ID Email ID

FAMILY DETAILS:-
S.No. Name Relationship Date of Birth Occupation

LANGUAGE PROFICIENCY (Please Tick - √)

Language Speak Write
Hindi
English
Any Other ( )

Major Strength Improvement Area Hobbies

Reference Document No. QP/HRD/01

CONFIDENTIAL PROPRIETARY INFORMATION OF POLY MEDICURE LIMITED
 Document No. : F/HRD/21
Revision No. : 02
POLY MEDICURE LIMITED
Page No. : 02 of 02
APPLICANT DATA FORM

EMPLOYEMENT HISTORY:-
Please list your most recent employer first and Onward (attach additional pages if required):

Salary Drawn
S.No Name & Address of the Company Period Designation
(CTC per Month)

EDUCATIONAL DETAILS:-
Qualification University / Board Specialization Year of Passing % age /CGPA

CERTIFIACTION / TRAINING ATTENDED DETAILS:-

Name Board / Society / Association Month / Year

REFERENCES :-

Reference No 1 Reference No 2
Name :- Name :-
Occupation :- Occupation :-
Address :- Address :-
Mobile No :- Mobile No :-

The above details are true and best of my knowledge. I understand that any misrepresentation of facts may be called for
disciplinary action.

Name:-_____________________ Signature: - _________________ Date: - _____________________

Reference Document No. QP/HRD/01

CONFIDENTIAL PROPRIETARY INFORMATION OF POLY MEDICURE LIMITED