TCS EMPLOYMENT APPLICATION FORM

Basic Details
EP Reference # : EP2010CN341270

Personal Details :
Name : Father's Name : Date of Birth : Gender : Nationality : Country of Residence : E-mail ID: Languages Known :(Mother Tounge appearing first) Mr. Ravi Nath Dixit Mr. PRABHU NATH DIXIT 30/06/1982 Male India India dixitravi69@gmail.com PAN # : AQJPD4291R

Language Hindi Kannada English

Speak Yes Yes Yes

Read Yes No Yes

Write Yes No Yes

ADDRESS DETAILS :
Present Address : 2711,6TH MAIN ,KUMAR SWAMY LAYOUT 2ND STAGE BANGALORE India 9731811332 State : Pin Code : Karnataka 560078

City : Country : Landline/Mobile:

Is the permanent and present address same? Permanent Address:

No

CK 64/36 HIRAPURA JALPADEVI VARANASI India 919236741395 State : Pin Code : Uttar Pradesh 221001

City : Country : Landline/Mobile:

Private and Confidential

Private and Confidential

ACADEMIC DETAILS :
Qualification : Starting from the latest qualification earned till class X or equivalent Is your PG a 5 year integrated course: No

Degree/Diploma

Passing Year

Specialisation/Major Subject

University/Institute

Course Type

Duration From

To

% of Marks(Agg. of all semester/ grade obtained 57.00

Awards and Scholarships

Bachelor Degree

BACHELOR OF COMMERCE IXTH STANDARD

2002

ADMINISTRATION

MAHATMA GHANDHI KASHI VIDYAPEETH,VARANASI U.P.BOARD

Full time

Jul-1999

Jun-2002

11th & 12th / PreUniversity 10th/SSC

1999

XII STD

Full time

Jul-1997

Jun-1999

54.00

SSC

1997

XSTD

U.P.BOARD

Full time

Jul-1996

Jun-1997

54.00

Break in Studies

Break in Study (Reason and Duration) :

Nil

EMPLOYMENT DETAILS TILL DATE :

Needs To be supported by relieving/release letter at the time of joining

Name of Company

Address of Company Start Date

Duration End Date

Post/Designation

Duties/Nature of Work

Annual Gross Salary

Others -PalmSure Solutions Pvt.Ltd

#3 Hemagiri,1st Floor ,Mysore Bank Colony,7th Main BSK 1st Stage,Bangalore

02-Jan-2012

29-Apr-2013

Dy. manager- Technical

Technical support

` 300000

Others -MERLINHAWK ENGINEERING PVT.LTD.

BANGALORE

26-May-2008

31-Dec-2011

ENGINEER

MANAGER

` 129396

Private and Confidential

Others -CLIVE SYSNET PVT.LTD.

BANGALORE

01-Jan-2007

25-May-2008

CUSTOMER SUPPORT OFFICER

MANAGER

` 96000

Break During Employment (Reason and Duration) : Break between Studies and Jobs

Nil

Duration From Jul-2006

Duration To Dec-2006

Reason looking for job

Total IT Experience Total Non IT Experience Are you currently Employed Service Bond Details

60

Months

0 Months Yes No

Private and Confidential

TCS RELATED DETAILS :

TCS Test/Interview :

Position

Date

Place

Final Result

REFERENCE DETAILS :
Reference 1 Name Designation Organisation Name Address Contact Number Nature of Acquaintance Period of Acquaintance Reference 2 Name Designation Organisation Name Address Contact Number Nature of Acquaintance Period of Acquaintance RAGHAVENDRA RAJE URS DIRECTOR CLIVE SYSNET PVT.LTD. 2711,6TH MAIN,2ND STAGE ,KUMARSWAMY LAYOUT BANGALORE 919035146469 FRIEND 5 Years , KIRAN KUMAR HS GERENAL MANAGER MERLINHAWK ENGINEERING PVT.LTD 57/5,TANK BUND ROAD,N.S.PALYA ,2ND BTM LAYOUT BANGALORE 919845687005 FRIEND 3 Years ,

Joining Details :
Expected Cost to Company(CTC) : ` 250000

DECLARATION :
Declaration and General Consent to Background Investigation:
In connection with my application to render services to Tata Consultancy Services Ltd (the "Company"), I hereby agree as follows: I certify that the information furnished in this form as well as in all other forms filled-in by me in conjunction with my employment is factually correct and subject to verification by TCS including Reference Check and Background Verification. I accept that an appointment given to me on this basis can be revoked and/ or terminated without any notice at any time in future if any information has been found to be false,misleading, deliberately omitted/ suppressed.

Private and Confidential

As a condition of Company's consideration of my application for employment with the Company, I hereby give my consent to the Company to investigate or cause to be investigated through any third parties my personal, educational and pre or post employment history. I understand that the background investigation will include, but not be limited to, verification of all information given by me to the Company. I confirm that the Company is entitled to share such investigation report with its clients to the extent necessary in connection with the Services, which I may be required to provide to such clients. I confirm and undertake that the Company shall incur no liability or obligation of any nature whatsoever resulting from such investigation or sharing of the investigation results as above. I certify that I am at present in sound mental and physical condition to undertake employment with TCS. I also declare that there is no criminal case filed against me or pending against me in any Court of law in India or abroad and no restrictions are placed on my travelling anywhere in India or abroad for the purpose of business of the company. Your Electronic Signature is : Name : Mr. Ravi Nath Dixit Date :Tue, 30 Apr 2013 Place :BANGALORE

TCS is an equal opportunity employer that aims to integrate global diversity and inclusion at each level within our organization.Hiring decisions are solely made on the capability of an individual to perform a role. Any personal details like gender,age and nationality,that may be provided by you during the course of application or selection process will be used for administrative records and all qualified applicants will receive consideration for employment without regard to this information.

Private and Confidential