This 5-page document is an application for employment at XYZ LTD. It requests information about the applicant's personal details, education history, employment history, salary, health, references, and includes a declaration. The applicant is asked to provide personal information like name, address, contact details, religion, marital status, as well as employment details including organizations worked for, designations, durations, salaries. Educational qualifications from highest to lowest are also to be included. The applicant must declare that all information provided is true to the best of their knowledge.

1. Page 1 of 5
XYZ LTD
Application for Employment (Should be filled by candidate only)
Instruction to fill in the Form:
o Please fill in the form in BLOCK LETTERS only
o All the Fields must be filled completely
o Please tick the appropriate box as applicable
o Please attach a copy of your CV/Resume along with this form
o Please attach supportive documents for the details furnished
Position Applied for
Location/HQ & State Ready to Relocate? Yes/No
Total number of Years of Relevant Experience
Present Salary Expected Salary
How did you get the
information about this
Opening?
Recruitment
Ad
Company
Website
Online Job
Portals
Reference Others
PERSONAL DETAILS
Title Mr Ms Mrs
Name In full
Sir Name
Date Of Birth (DD/MM/YYYY) & Age
Father’s/Husband’s/Guardian’s Name
Religion and Nationality
Marital Status Single Married Divorced
Address (With PIN Code)
Permanent Correspondence
Telephone No’s (For both Permanent and
Correspondence addresses)
Landline(With STD Code) Mobile No’s
i)
ii)
i)
ii)
Active Email ID’s
i)
ii)
ADHAAR CARD Number/PASSPORT Number
PAN Number
Details of Valid Driving License (Applicable
for Sales Staff)
Do you own a two wheeler? If yes, details
Statutory Information
EPF Membership ESIC IP Number Others, if any
Have you ever employed at XYZ Ltd? Yes No Details, if yes
Affix a recent
passport size
photograph

2. Page 2 of 5
Details of Education
Course/Degree/ Diploma (Details
of SSC(X Class), Inter, Graduation,
Post Graduation, Diploma, Begin
with Highest)
Board/University
Academic Years
% of
Marks
Class/
GradeFrom To
DETAILS OF PROFESSIONAL TRAIANING OBTAINED
Name of the Program Description Institute Purpose
LANGUAGES KNOWN (TICK THE APPROPRIATE ONE)
ENGLISH HINDI
OTHERS – I OTHERS – II
( )
OTHERS – III
( )
Read Write Speak Read Write Speak Read Write Speak Read Write Speak Read Write Speak
DETAILS OF CURRENT EMPLOYMENT
Designation Organization Location
Period Total
Duration
Reason for Leaving
From To

3. Page 3 of 5
DETAILS OF PREVIOUS EMPLOYMENT (Begin with the recent employment)
Designation Organization Location
Period
Total
Duration
Reason for
Leaving
From To
DETAILS OF YOUR SALARY DURING THE LAST 3 EMPLOYEMENTS (Write in reverse
chronological order)
Designation
Name of the Organization Salary
Other
Allowances,
if any
CTC/Gross
Salary
HIGHLIGHTS OF YOUR CAREER (ACADEMIC OR PROFESSIONAL)

4. Page 4 of 5
INFORMATION ON YOUR HEALTH
Blood Group and Rh Factor
Details of Physical Disabilities, if any
Details of Major illness, chronic Diseases, Accidents,
Surgeries , etc
Allergic to
DETAILS OF CRIMINAL RECORD/ POLICE CASES/ COURT CASES/ FIRs, IF ANY. IF
THERE IS NOTHING, PLEASE MENTION “ NO”
DETAILS OF FAMILY MEMBERS
Name Date of Birth & Age Relationship Occupation
IN CASE OF EMERGENCY, PERSON/S TO BE CONTACTED
Name Relationship Address Contact Number/s

5. Page 5 of 5
REFERENCES (1 from Personal front+ 1 from Professional front)
Name Relationship Occupation
Known for
No. of Years Address & Contact Number/s
Other information
I, declare that the particulars given above are correct and true to the best of my knowledge
and belief and no attempt has been made by me to Conceal or withhold pertinent
information, which you are at liberty to verify at any time. I also understand that any
misrepresentation of facts in the application is sufficient cause for termination of my services,
if appointed.
Station:
Date: Signature:
( )