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DATA FORM
 -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                                                              PART A
                                                                                                     PERSONAL DETAILS
                                                                                                                                                                                                                Photograph
Full Name (First/Middle/Last):

Mobile Number:                                                                                         Alternate Number:

Email ID:

Nationality:                                                                                           Passport Number:

Date of issue:                                                                                         Date of expiry:

Social Security Number (If worked/studied in the US/Any other Country):
Change of Name (if Applicable)

Former Name/Maiden Name:                                                                                                                                       Date of Name Change:


Current Address:                                                                                                            Permanent Address:



                                                                   City:                                                                                                                        City:

Telephone:                                                     Pin code:                                                    Telephone:                                                          Pin code:
Religion:                                               Date & Place of birth:                                              State of Domicile:

                                                                                                                               th
                                                                          EDUCATION DETAILS (10 ONWARDS)
                                                                                                    Duration of
                                                                                                    Course                                                                                                     Course Type
                                                                                    Student ID No./
Course/             University/                         School/College (Name, City,                 (Yrs.)                                                                                   Percent           (Full time/Part
                                                                                    Enrolment No./                                                                Specialization
Degree              Board                               Pin code)                                                                                                                            age               Time/
                                                                                    Seat No.        From-To
                                                                                                                                                                                                               Correspondence)
                                                                                                    (MM/YYYY)
EMPLOYMENT DETAILS (Start from the current company)

                                                              Where are you employed?                      Registered Corporate Office        Branch
Name of Company:                                              Office

Company Address (Where you are employed):                     Period of employment: (DD/MM/YY to                     Designation:
                                                              DD/MM/YY):


                                                              Department:                                            Emp. Code:
                                                              Employment Type:              Permanent                Total CTC: (Fixed + Variable)
                                                                 Temporary                  Contractual


(Supervisor      Name:                                                          Designation:
Details)         Email id:                                                      Landline:
State your reason for leaving:

Details of any existing service contract/bond:




                                                              Previous Experience

   Name & Address of             From           To                                           Gross Salary (Per Month)
                                                                Position held                                                  Reason for leaving
     organization                   (MM/YYYY)                                                  Start          Last




Any gaps in education or employment? (If yes, please mention details with month and year):




Details of two persons (excluding relatives) for reference:
Name:                                                                              Name:

Address:                                                                           Address:




Occupation:                                                                        Occupation:

Contact No.:                                                                       Contact No.:

Email Id:                                                                          Email Id:
PART B


Post applied for:                                                              Department:
Parents’ Name & Occupation:                                                    Siblings’ Name & Occupation:




Marital Status:                                                                No. of Children & Age:
Spouse Name, Profession & Nationality:                                         Languages Known                    Speak         Read             Write




Whether working with MBRDI:

Particulars of relatives who are Directors or Employees of MBRDI (specify      Particulars of previous Tests / Interviews with MBRDI (if any):
relationship):


Height:             Weight:            Blood Group:              Vision        Physical Disability (if any):         Details of any major
                                                         Left:        Right:                                         illness/accident/operation:


                                                                 TRAINING UNDERGONE

                       Institution                               From            To           Stipend (if                 Training Contents
                                                                                                 any)




Details of Extra Curricular Activities / Hobbies:                                          Membership and office held in any organization / association
                                                                                           including any professional body relevant to the job applied
                                                                                           for:
Details of noteworthy work done and results achieved in the last three positions:




Other facts (special skills / activities) relevant to the position applied for which have not been covered earlier:




Career Goal:




Break-up of minimum expected salary:                                           Justification:




Willingness to be transferred to any place on Company’s service (India or      Time required to join:
abroad):
                   Yes                   No
Authorization/ Declaration and Undertaking
If shortlisted by Mercedes-Benz Research and Development India Private Limited (MBRDI), I agree to provide self-attested copies of all relevant
certificates as requested by MBRDI. I understand that employment with Mercedes-Benz Research and Development India Private Limited is
governed by their employment policies and other applicable relevant guidelines, including satisfactory information from background checks.

I hereby certify that all information provided herein, is true and complete to the best of my knowledge and belief. I authorize the HR department of
Mercedes-Benz Research and Development India Private Limited to authenticate/share information that I have provided in my resume and
various other documents and this Data Form by sharing it with various agencies for purely official purposes as deemed fit by MBRDI. I also authorize
MBRDI or its partner agencies to conduct enquiries as may be necessary at the company’s discretion; I authorize all who may have information
relevant to this enquiry to disclose it to Mercedes-Benz Research and Development India Private Limited and/or its representatives. I release all
concerned from any liability on account of such disclosures.

I also declare that the information provided by me in my resume and application for employment to Mercedes-Benz Research and Development
India Private Limited and its representative is authentic and if any of this information is found to be false / incorrect, the Company would be free to
terminate my services / cancel my selection / appointment or take any legal action deemed fit by MBRDI.

I consent to extend total co-operation and provide relevant documents required.


Full Name of the Candidate: ___________________________________________                                        Signature of the Candidate

Current Location: ____________________________________________________

Date: ______________________________________________________________

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2012 01 25 new data form mbrdi

  • 1. DATA FORM ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- PART A PERSONAL DETAILS Photograph Full Name (First/Middle/Last): Mobile Number: Alternate Number: Email ID: Nationality: Passport Number: Date of issue: Date of expiry: Social Security Number (If worked/studied in the US/Any other Country): Change of Name (if Applicable) Former Name/Maiden Name: Date of Name Change: Current Address: Permanent Address: City: City: Telephone: Pin code: Telephone: Pin code: Religion: Date & Place of birth: State of Domicile: th EDUCATION DETAILS (10 ONWARDS) Duration of Course Course Type Student ID No./ Course/ University/ School/College (Name, City, (Yrs.) Percent (Full time/Part Enrolment No./ Specialization Degree Board Pin code) age Time/ Seat No. From-To Correspondence) (MM/YYYY)
  • 2. EMPLOYMENT DETAILS (Start from the current company) Where are you employed? Registered Corporate Office Branch Name of Company: Office Company Address (Where you are employed): Period of employment: (DD/MM/YY to Designation: DD/MM/YY): Department: Emp. Code: Employment Type: Permanent Total CTC: (Fixed + Variable) Temporary Contractual (Supervisor Name: Designation: Details) Email id: Landline: State your reason for leaving: Details of any existing service contract/bond: Previous Experience Name & Address of From To Gross Salary (Per Month) Position held Reason for leaving organization (MM/YYYY) Start Last Any gaps in education or employment? (If yes, please mention details with month and year): Details of two persons (excluding relatives) for reference: Name: Name: Address: Address: Occupation: Occupation: Contact No.: Contact No.: Email Id: Email Id:
  • 3. PART B Post applied for: Department: Parents’ Name & Occupation: Siblings’ Name & Occupation: Marital Status: No. of Children & Age: Spouse Name, Profession & Nationality: Languages Known Speak Read Write Whether working with MBRDI: Particulars of relatives who are Directors or Employees of MBRDI (specify Particulars of previous Tests / Interviews with MBRDI (if any): relationship): Height: Weight: Blood Group: Vision Physical Disability (if any): Details of any major Left: Right: illness/accident/operation: TRAINING UNDERGONE Institution From To Stipend (if Training Contents any) Details of Extra Curricular Activities / Hobbies: Membership and office held in any organization / association including any professional body relevant to the job applied for:
  • 4. Details of noteworthy work done and results achieved in the last three positions: Other facts (special skills / activities) relevant to the position applied for which have not been covered earlier: Career Goal: Break-up of minimum expected salary: Justification: Willingness to be transferred to any place on Company’s service (India or Time required to join: abroad): Yes No
  • 5. Authorization/ Declaration and Undertaking If shortlisted by Mercedes-Benz Research and Development India Private Limited (MBRDI), I agree to provide self-attested copies of all relevant certificates as requested by MBRDI. I understand that employment with Mercedes-Benz Research and Development India Private Limited is governed by their employment policies and other applicable relevant guidelines, including satisfactory information from background checks. I hereby certify that all information provided herein, is true and complete to the best of my knowledge and belief. I authorize the HR department of Mercedes-Benz Research and Development India Private Limited to authenticate/share information that I have provided in my resume and various other documents and this Data Form by sharing it with various agencies for purely official purposes as deemed fit by MBRDI. I also authorize MBRDI or its partner agencies to conduct enquiries as may be necessary at the company’s discretion; I authorize all who may have information relevant to this enquiry to disclose it to Mercedes-Benz Research and Development India Private Limited and/or its representatives. I release all concerned from any liability on account of such disclosures. I also declare that the information provided by me in my resume and application for employment to Mercedes-Benz Research and Development India Private Limited and its representative is authentic and if any of this information is found to be false / incorrect, the Company would be free to terminate my services / cancel my selection / appointment or take any legal action deemed fit by MBRDI. I consent to extend total co-operation and provide relevant documents required. Full Name of the Candidate: ___________________________________________ Signature of the Candidate Current Location: ____________________________________________________ Date: ______________________________________________________________