Personal History Form (Candidate)

Post Applied For:

Referred by:

Instructions for filling Personal History form:

Fill in all the relevant columns in the form.
Fill in your academic, technical and professional qualifications, starting with the highest educational
qualification.
Fill in your past employment record, starting with your latest employment.

Please stick
your recent
passport size
photograph
here.

1 PERSONAL DETAILS
Name

Middle Name

Weight (kgs)

Height (cms)

Surname

Category (please tick)

General SC ST OBC
Date of Birth (dd/mm/yy)

Marital Status (Please tick)

Distance from Int'l Airport

Married Single Others

Kms.

Present Address

District

Others __________________________
Mode of transport to work (Please tick)

Public

Private Self Owned

Permanent Address

State

Mobile Phone

Pin code

District

Tel (Home)

State

Pin code

Email Address

2 ACADEMIC QUALIFICATION
Starting with school/college most recently attended, list in date order all periods of education. Include all High Schools: Vocational / Technical schools: junior colleges
military schools; colleges; graduate schools; and equivalency diplomas.

Institution Name

Fro
m (month/year)

Institution Address

To (month/year)

Passed

Program

Yes
Type of degree / diploma / certificate

Part time

Passing date (month/year)

Institution Name

Fro
m (month/year)

No

% Class

Full Time
Major/Specialized Subjects.

Institution Address

From (month/year)

Type of degree / diploma / certificate

Passed

Program

Yes

No

Type of degree / diploma / certificate

Part time

% Class

Full Time
Passing date (month/year)

Rev. No: 0
Eff. Date: 01/07/2012

Doc. No: FM/GRP-HRD/10

Approved By: SalBrosGroup

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Personal History Form (Candidate)

Institution Name

From (month/year)

Institution Address

From (month/year)

Type of degree / diploma / certificate

Passed

Program

Yes

Full Time
Type of degree / diploma / certificate

Institution Address
To (month/year)

Passed

Program

Yes
Type of degree / diploma

% Class

Part time

Type of degree / diploma / certificate

Institution Name

From (month/year)

No

/ certificate

No

% Class

Part time

Passing date (month/year)

Full Time
Major/Specialized Subjects.

3 Other Achievements (list your other achievements

4 Employment Record (List all former employers)

Starting with your present or most recent employer, account for all periods when you were employed. Complete and accurate dates (month/year) must be provided. YOU
WILL BE REQUESTED TO PROVIDE VERIFICATION OF SALARY AND OTHER COMPENSATION THROUGH WAGE STATEMENTS AND / OR PAYROLL RECEIPTS.

Employer:

Assignment type:

Part time

From (month/year)

Address:

Telephone Number:

Last Position Held:

Reported to: Name / Designation

Final Salary:

Job Description:

To (month/year)

Full Time

Employer:

Reason for Leaving:

Assignment type:

From (month/year)

To (month/year)

Part time Full Time

Address:

Telephone Number:

Last Position Held:

Reported to: Name / Designation

Final Salary:

Job Description:

Reason for Leaving:

Rev. No: 0
Eff. Date: 01/07/2012

Doc. No: FM/GRP-HRD/10

Approved By: SalBrosGroup

Page 2 of 4

Personal History Form (Candidate)

Employer:

Assignment type:

From (month/year)

Part time Full Time

Address:

Telephone Number:

Last Position Held:

Reported to: Name / Designation

Final Salary:

Job Description:

To (month/year)

Employer:

Reason for Leaving:

Assignment type:

From (month/year)

To (month/year)

Part time Full Time

Address:

Telephone

Last Position Held:

Reported to: Name / Designation

Final Salary:

Job Description:

Number:

Reason for Leaving:

5 References (Please list at least three)

Please give names of responsible persons not related to you and qualified to supply definite information regarding your character and ability.
Name of reference

Designation

Company name and address

Telephone number

6 Family Details (Please include your Parents, Brothers, Sisters, Spouse & Children)
Full Name

Relationship

Date of Birth

Residential Address & Tel No.

Last designation & Companys Name

Rev. No: 0
Eff. Date: 01/07/2012

Doc. No: FM/GRP-HRD/10

Approved By: SalBrosGroup

Page 3 of 4

Personal History Form (Candidate)

6 Family Details (Please include your Parents, Brothers, Sisters, Spouse & Children)
Full Name

Relationship

Date of Birth

Residential Address & Tel No.

Last designation & Companys Name

7 Next of Kin / Emergency Contact. (Has to be a sibling/Relative residing locally)

First Name

Middle Name

Last Name

Relationship

Address

Telephone Number
Cell phone number

8 Languages Known (Please Tick)

Language

Excellent

Read
Good

Excellent

Written
Good

Fair

Excellent

Speak
Good

Fair

Have you ever been arrested, indicted, or summoned into court as a defendant in a criminal proceeding, or convicted, fined
or imprisoned for the violation of any law (excluding minor traffic violations)?
YES

NO (If "YES", give full particulars such as dates, charges, results) of each case in an attached statement.)

Serious illness including hospitalization if any.

Fair

YES

NO (If "YES", give full particulars)

________________________________________________________________________________________________________
Are you presently taking medicines for any illness/disease if yes kindly provide details:
________________________________________________________________________________________________________

State any other relevant facts in support of your application if any.

Declaration:I hereby declare that the statements made by me in answer to the foregoing questions are true, complete and correct to the best of my
knowledge and belief. I understand that any misrepresentation or material omission made on a Personal History Form or other
document requested by Cargo Service Center India Pvt. Ltd.) Renders me liable to termination or dismissal without notice.

Date: ______________________________

Place:________________________________ Signature: __________________________

Rev. No: 0
Eff. Date: 01/07/2012

Doc. No: FM/GRP-HRD/10

Approved By: SalBrosGroup

Page 4 of 4