1

Recent
Photograph
Godrej & Boyce Mfg. Co. Ltd. (in
professional
APPLICATION FORM attire)

POST APPLIED FOR : _QA QC ENGINEER (PIPING/WELDING)______________________________

FULL NAME : Mr. / Ms. __NILLA TRINADH VENKATA

KUMAR________________________________________________________________
( Surname ) (First Name ) ( Middle Name)

ADDRESS FOR COMMUNICATION (Local) PERMANENT ADDRESS ( Native Place)

Mobile No.:
E-mail ID Phone :

DATE OF BIRTH : ___ / ___ / _______ PLACE OF BIRTH :_______________NATIONALITY :_____________

DO YOU BELONG TO: SC ______ ST _____ OBC _____ OTHERS ______

LANGUAGES KNOWN : ( Communication Skills )

Languages Speak Read Write

EDUCATIONAL QUALIFICATION:

Examination Full-time / Duration of Course Month & Name & Location of Class /Grade &
Passed Part-time or Year of School/College/U’sity/Board Percentage
From To
Corres. Passing (City & State) of marks
MM/YY MM/YY
SSC

HSC

Was there any break in your studies? No / Yes (If yes, please mention the reason for the same)

_____________________________________________________________________________________________________

KNOWLEDGE OF COMPUTERS: _____________________________________________________________________

Contd. ( 2 )
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WORK EXPERIENCE : (- Including practical training, if any.

- Please write in chronological order ending with present employment)

Period
Experience Annual Reasons
From To Name & Location of Designation and
( in Cost to for
(DD/MM/ (DD/MM/ Employer / Self Employment Nature of Work
months ) Company Leaving
YY ) YY)

BREAKUP OF THE PRESENT / LAST SALARY, BENEFITS & PERQUISITES :

Components Rs. ( p.m.) Components Rs. (p.m.)

Monthly Benefits Annual Benefits

Basic Salary Leave Travel Allowance (LTA)

House Rent Allowance Mediclaim / Hospitalisation Insurance
( Coverage Amount Rs. __________)
Medical Expense Reimbursement Any Other
Education Allowance
Lunch / Canteen TOTAL ( B ) :
Conveyance Allowance
Telephone Expense Reimbursement Terminal Benefits
Other Allowances: a) Provident Fund
b) Gratuity
c) Superannuation
d) Any Other
TOTAL ( A ) : TOTAL ( C ) :

Cost to Company ( p.a.) : ( A + B + C ) X 12  Rs. ________________ /-

Expected Remuneration : Monthly Gross : Rs. _____________ Cost to Company ( p.a.) : Rs. ________________

REFERENCES : ( Name relatives / acquaintances in any of the Godrej establishments )

Name Division/Plant, Department & Location Relationship with

(Specify State & District ) the applicant
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Contd… ( 3 )

SOURCE OF RECRUITMENT (DETAILS OF YOUR INTRODUCTION TO US):

Self / Placement Consultant / Advertisement (Newspaper / Godrej Website / Any other Job Portal) / Campus Interview / Employee
Reference / Job Fair / Walk-in / Employee’s Son / Daughter / Ex-Trainee (Summer / Project / In-Plant) / Temp. Staff.
Please mention the exact detail here: ____________________________________________________ (For example, if you are
referred by a Placement Consultant, please mention the name of the Firm / Agency).

Please explain in brief why you consider yourself suitable for the position applied for ?
a) ____________________________________________________________________________________

b) ____________________________________________________________________________________

c) ____________________________________________________________________________________

Which functional area do you prefer ? ________________________________________________________

( List in order of preference. E.g. Sales, Service, Production, Quality Control, Design, Maintenance etc)

Are you planning for higher studies ? If yes, please specify _______________________________________

Weekly off day(s) in your present employment : _______________________________________________

Have you been previously tested / interviewed by us ? If yes, state when & for what post ? Yes / No
_________________________________________________________________________
How soon would you be able to take up the new appointment, if selected ? _______________________

DECLARATION

I declare that the foregoing information is correct and complete to the best of my knowledge and belief and nothing has been concealed. I
accept that the statement made by me and the information supplied by me shall form the basis of my employment / traineeship with the
Company. If at any point in time in future, I am found to have concealed any material information or given false details against any of the
above particulars, my appointment / traineeship shall be liable to summary termination without notice or payment in lieu of notice.

Date : ___/ ___/ ________ _________________________

Place : ________________ (Signature of the Applicant)

Note:

1. If appointed, you are liable to be posted and/or transferred to any of the Company’s Establishments
within the Territories of India.

2. All appointments are subject to the candidate being declared medically fit by the Company’s Medical
Officer or a Medical Practitioner of Company’s choice. The Management’s decision in this regard is final.

(For office use only)

GI Raw ________ GI Stanine _________ MC Raw _______ MC Stanine ________ Written English: __________

Date of Test: ___________________ Conducted by: _______________________ Signature: ____________________

Special approval (if any) by Head - HR _______________________________________________________________