EMPLOYMENT APPLICATION

01. Please answer each column fully and neatly in your own handwriting.
PERSONAL DETAILS

NAME IN FULL(in block letters)

First name middle name surname
Current Bank Name : ______________________ Current Bank Account No : __________________

PAN Card No: _______________ Name of the Branch : _______________________

Passport No : __________ Date of Issue : ________ Expiry Date : ____________ Place of Issue:___________

ADDRESS FOR COMMUNICATION PERMANENT ADDRESS

* Mobile no: ____________ Tel no: __________

* Tel no ______________
* Personal Email Id : ______________________ *Mobile No: _________________

DATE OF BIRTH: PLACE OF BIRTH:

(dd/mm/yy) Village:____________ Taluka : _____________ District :______________

City: ________________State:_________________Country : _____________

GENDER: RELIGION: MARITAL STATUS:

Married Unmarried
Male Female
Date of Wedding :
HEALTH

BLOOD GROUP : VISION : LAST MAJOR ILLNESS/SURGERY :

Long sight : (Specify date):

Short sight :
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Are you Suffering from any of the following diseases? If Yes, Please tick in the

BP Diabetes Asthma Chronic Bronchitis Skin Diseases Venereal Diseases AIDS etc.

02. Please tick in the wherever applicable.

*Have you been referred by any of the RAYO PHARMA Employee? Yes No
 If Yes, Please mention the Employee Name___________________________ and Employee Code _________
FAMILY DETAILS

Name Age DOB Occupation Address

Father

Mother

Spouse

Children: 1

Brothers: 1

Sisters : 1

2
EDUCATIONAL DETAILS

Level Name of the Board/ Year attended Mediu Subjects/ Area Marks
institution Univer m of (% /
From To
sity Specialization CGPA)
X standard

Intermediate

Graduation

Post-
Graduation

Others

Any Educational courses that you are currently pursuing?

Course Name _________________ Name of the university ______________ Duration ______________

Mode of the course: Regular Part-Time Distance

Expected year of completion of the course: ____________

Academic Achievements (Ranks, Merit Scholarships, Prizes, etc.)

,

Extra-Curricular Activities:
 WORK EXPERIENCE PLEASE WRITE ‘NA’ IF NOT APPLICABLE:
Specify clearly in case of part time/contract work experience.

Organization Period Full time/ Designation Reason for Last dr

From To Duration part time/ leaving salary
(mm/yy) (mm/yy) (in months) contract (per mo
NOITANIMON

Nominate the person to be contacted in case of emergency:

Name : Address :

Relationship:

Contact number :
REFERENCES

LIST PROFESSIONAL REFERENCES (not related)

Name & Address Occupation Email Contact Number

Do, you know any of the employee from Rayo Pharma P. Limited Yes No
If yes, please fill the details
LANGUAGES
MOTHER TONGUE:

Languages known Can Can Can Can

(other than mother tongue) : Understand Speak Read Write

__________________________

__________________________

__________________________
MISCELLANEOUS

Do you have any legal obligations to your previous employer /employee? Yes No

If yes, please mention :

Have you at any time been convicted by a court of India for any criminal
offence and sentenced to imprisonment, or any criminal proceedings Yes No
are pending against you before a court in India.

If yes, please specify the details

DECLARATION

I certify that the above – stated information is TRUE to the best of my knowledge & belief . All the academ
marks / percentages / CGPA / years are true. I agree that in case the company finds at any time that t
information given by me in this form is not correct, the company will have the right to withdraw my letter
appointment or to terminate my appointment at any time without notice or compensation .

Date: ________________ Signature : _______________________

OFFICE USE ONLY

Date of application : ____________________ Joining Date : ______________________

Emp Code : ______________ Designation : ______________

Date of Offer and Acceptance : ________________ Reporting Relation : ____________________

Department / Division : __________________ Location of the branch / HQ : __________________

Signature of the HR :________________ Corporate E-mail id : ____________________