APPLICATION FOR EMPLOYMENT

Personal Information

First Name Middle Name Last

Name Kindly affix your
Mr. /Ms. recent Passport size
(Expand all Names) Photograph Here
1. Position Applied For:
2. Who referred you for this position: Consultant Advertisement Direct Application
Friend Relative* (Please provide the name of the referral):
*Nature of Relationship:
3. Is your friend / relative a JUSCO or Tata Group employee: Yes/No
4. If answer to Q3 is “Yes”, please write his / her Name & Personnel No. :
Date of Birth E-mail ID:
d d m m y y y y Alternate e-mail ID (if any):
Phone No: Alternate Phone No.:
Gender: Marital Status:
Caste: Category: SC/ST/OBC/General

PERMANENT ADDRESS TEMPORARY/CURRENT ADDRESS

Add. Line 1: Add. Line 1:

Add. Line 2: Add. Line 2:

City: District: City: District:

Pin Code: Pin Code:

State: State:

Note: If Local Address is same as Permanent Address, only fill Permanent Address and tick in this box:
EDUCATION (Begin with the most recent qualification and end with Std. X)
Course/ Specialization Name of Regular (Full From To Aggregate Marks
Degree (Please Institute/University Time/Part-time/ (mm/yy) (mm/yy) (% or CGPA)
mention your with Location Correspondence)
core subjects)

JUSCO Ltd./HRIR/PPF Effective Date: 01/02/2016

PREVIOUS EMPLOYMENT DETAILS (Start with most recent employment and go backwards)
From To Date Organization Location Industry type Last Designation
Date

In case there’s a gap in employment periods, kindly indicate reasons for the same below:

CURRENT/LAST EMPLOYMENT DETAILS

Period of No. of Annual
Reporting Employee
Company Name Designation employment reportees Turnover
to Strength
(in months) (if any) (in Crs.)

Type of Employment: Regular / Contract / On Probation

Job Responsibilities in the Current Role

Key Responsibilities Major Achievements

JUSCO Ltd./HRIR/PPF Effective Date: 01/02/2016

CURRENT COMPANY CTC BREAK-UP
Mention % of Basic wherever applicable
Current Compensation Remarks (Frequency
% of Basic Monthly (Rs.) Annual (Rs.)
of payment)
A Basic
ALLOWANCES (CASH) for e.g. – D.A., Conveyance, Location, Education, LTA etc)

Allowances (Cash) - Total

ALLOWANCES (NON-CASH) for e.g. – Costed value of accommodation, Medical, Food Coupons etc)

Allowances (Non- Cash) - Total

BONUS

Bonus (Total)
RETIRALS
Provident Fund
Gratuity
E
Superannuation

Retirals - Total
CTC (A+B+C+D+E)

Expected CTC Expected Monthly Gross

Notice Period (in months)

JUSCO Ltd./HRIR/PPF Effective Date: 01/02/2016

Do you have any commitment / bond/ contract with current employer which might affect
your employment with us: YES/ NO
If the answer to the above question is “YES”, then please specify the details:

Reason for leaving last job:

Have you been interviewed by us in the past: YES/NO

If the answer to the above question is “YES”, then please furnish details below:
Date of Interview Result of interview
Position for which you were interviewed
If you are related to any of the employees in JUSCO, fill the following details:
Name Designation Personnel No. Nature of Relationship

FAMILY DETAILS (including self, parents, spouse & children)

Name Relationship Age Occupation Details of illness, if any

MOBILITY INFORMATION: Do you have any reservations with being posted to any specific location
across India or abroad? YES/NO.
If your answer is “YES”, then please indicate reasons below:

JUSCO Ltd./HRIR/PPF Effective Date: 01/02/2016

 GENERAL DETAILS:
Languages Knowledge Read Write Speak

Identification Details:
Document Type Document No. Document Issue Date Valid Till
Passport

Aadhaar Card

PAN Card

Driving License

REFERENCES (Details of 2 persons other than your relatives)

Name Organization Designation Telephone Email ID

DECLARATION
I hereby declare that all the information given is true to the best of my knowledge. If any information furnished is
found untrue or incorrect at any point of time, in any respect, the company has the right to terminate my services
without notice or salary in lieu thereof.

Place Date Signature

JUSCO Ltd./HRIR/PPF Effective Date: 01/02/2016