BRIDGESTONE INDIA PRIVATE LIMITED Plot No.12, Kheda Growth Centre, Post Sagore 454 774, Dist.

Dhar, (M.P.) India Tel.: (91-7292) 55021 (10 Lines) Fax: (91-7292) 55036 / 37 / 38 / 39 e-mail: bail@bom4.vsnl.net.in Post Applied Our Reference NAME (in block letters) PRESENT ADDRESS: Email: PERMANENT ADDRESS: Age: Date of Birth: Sex: MALE / FEMALE Phones: (O) (R) Phones: (O) (R) Height: Marital Status: Childrens Age: No. of other Dependants: Occupation: Address Spouse: Name Occupation: Address LANGUAGES Speak: Read: Write: Weight:

Disability if any: No. of Children: Father: Name

PRESENT EMPLOYMENT EMPLOYERS NAME & ADDRESS Date Joining Present EDUCATION: Start with latest Degree / Diploma and go Designation up to High School JOB DESCRIPTION Years Degree / Institution / % of Salary P.M. Main Subjects Division Diploma University Marks From To D.A. P.M. Allowance P.M. Total P.M. Perks Please draw the organisation chart of your dept. indicating clearly your level and one level below & above you.

Why do you desire to change your present job? HONOURS / SCHOLARSHIPS / DISTINCTIONS PUBLICATIONS (S) / PAPER / DISTINCTIONS Special Interests: (a) Academic / Professional subject (b) Hobbies / Sports

EMPLOYMENT HISTORY (Start with first job) 1. EMPLOYERS NAME & ADDRESS JOB DESCRIPTION Reason of leaving 2. EMPLOYERS NAME & ADDRESS JOB DESCRIPTION

Reason of leaving 3. EMPLOYERS NAME & ADDRESS JOB DESCRIPTION Reason of leaving Name Present Organisation Position Break up of Salary / Benefits (Converted into Per Month) 1. Basic 2. DA 3. Special Salary 4. HRA 5. CCA 6. Conveyance 7. Vehicle Maintenance 8. Books & Periodicals 9. Servant 10. Education 11. Utilities 12. Soft Furnishing 13. Hard Furnishing 14. Entertainment 15. LTA 16. Medical 17. Gratuity 18. Attaire 19. Bonus / Exgratia 20. PF 21. Others: ________________ ________________

Date Designation Salary P.M. D.A. P.M. Allowance P.M. Total P.M. Perks Date Designation Salary P.M. D.A. P.M. Allowance P.M. Total P.M. Perks Date Designation Salary P.M. D.A. P.M. Allowance P.M. Total P.M. Perks

Joining

Present

Joining

Present

Joining

Present

1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14.

________________ TOTAL PERKS (Please Specify) Housing Benefits Car & Car Related Benefits Overseas Travel Club Membership Telephone P&T / Cellular Personal Accident Insurance Credit Card Advance Management Programme Housing Loan Furnishing Loan Childrens Education Incentives Performance related pay Others

What do you consider your major career / other achievements and role you played in it?

What aspects of your job do you like most?

Why do you consider yourself suitable for the position applied?

Have you ever been interviewed by BSID before? Yes/No

if yes, give details

Are you relayed to any of the present employees / directors of BSID Group? Yes/No If yes, to whom? Describe relationship:

Have you ever been involved in any court proceedings? Yes/No If yes, give details Any other information, which you think, should be taken into account before considering your application.

Do you have any financial or other obligations for your present employer, like damage compensation etc.? If yes, please specify.

Are you ready to work anywhere in India? Please specify locational preferences, if any.

Are you ready to sign service agreement? Yes / No

Salary and other benefits expected :

Minimum time required for joining ?

REFERENCES : Please give name and addresses of three persons, preferably non-relation who know about your work and character. 1. 2. 3.

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