Employment Data Form

Please affix recent passport size photograph

Name:

(Surname)

(First name)

(Middle name)

Position applied for Name of the Group Company / Business Function Location

: : :

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A. Personal data 1. 2. Name: _______________________________________________________________________ Place of Birth: _____________________________ Date of Birth: __________________

3. Blood Group: _________________________________________________________________ 4. Present Address Permanent Address

5. Telephone No: (M)________________ Landline: Office_______ Resi.- _________________ 6. E-mail Address: ________________________________________________________________ 7. Permanent Account Number: (PAN Card) _______________________________________

8. Passport Number: ____________________________ Valid up to: _______________________ 9. Nationality: ____________________________________________________________________ 10. Domicile Details: State of origin: _______________________ (Indian Nationals) State of domicile: ____________________Since: __________ yrs. 12. Identification Mark: _____________________________________________________________ 13. Religion: ________________________ 14. Category: _______________ General ST SC OBC Other

15. Marital Status: _________________ Date of Marriage: _____________________ 16. Details of family members
Sr. No Name Relationship Date of Birth Occupation Name of Employer Dependent Yes/No

1. 2. 3. Childrens Details 1.
Sr. No

Name(s) of child / Children

Date of Birth

Sex

Std.

Board

Medium

Any other Information

2. 3.
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15. Languages Known: Hindi English

Mother Tongue: Regional / Vernacular / Other Pl. mention: ________ ________ ________

Read: Speak: Write: 16. Hobbies & Interests: _______________________________________________________ 17. Extra-curricular activities: __________________________________________________ 18. Please mention physical challenges, if any B. Education and training 1. Educational Record: (starting with SSC/ equivalent). Please mention PT for part-time and DL for distance learning courses in the second column
Sr. No. Degree/Diploma Certificate Year of Passing School/College Board/University No. of Attempts Duration of course Principal Subjects Percenta ge/ Grade

: __________________________________

2. Specialized Training/ Certification/s:

Sr. No.

Institute / Organization

Name of Course / Certificate

Period From To

Subject(s)

Percentage/ Grade

3. Details of membership in professional bodies / institutions:

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C. Employment History
1. Particulars of employment (starting from current employer):
Name & Location of employer Period of Service
From (dd/mm/yy) To (dd/mm/yy)

Designation Initial Last

Broad / Major Responsibilities

Please use additional sheets if required. Please give your current remuneration details on the last page of this form. I hereby declare that the information and details furnished herein regarding Employment History are true and complete to the best of my knowledge and belief. I have got Relieving Letter & Experience Letter from all the Previous Employers and will submit the same at the time of my Joining. If any information is found to be suppressed, misrepresented or false, I shall be responsible for the resultant consequences and shall render myself liable to disciplinary action.

Full Name: _____________________________________ Place: __________________ Date: _______________ Signature: __________________ 2. Your present job responsibilities:

3. Present organization structure:

Kindly circle your position and indicate your reporting relationship i.e. person to whom you report and who reports to you. Page 4 of 8

D.

General Information:
1. Significant achievements: distinctions/ honor/ awards received / Books / Papers published

Year

Details

2. What, according to you, are your strengths and areas for improvement?

Strengths:

Area for improvement:

3. Reason for contemplating a change from the present job.

4. Reason for seeking appointment in the Adani Group

5. Any other information you would like to offer, including other / personal details / special achievements, if any

6. Are you prepared to relocate to any of our businesses / locations in India / Abroad? Yes No

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7.

Are you related to any employee / associate of Adani Group?

Name(s)

:__________________________________________________________

Company /Business & Location: __________________________________________ Department: ____________________________________________________________ Designation: ____________________________________________________________ Nature of Relationship/Acquaintance: ___________________________________________ Note: Please furnish full details of all persons related or known to you. Attach/use additional sheet if required. 8. Have you been interviewed by us / any of our group companies in the past?
Yes If yes, give below details: No

Position: _____________________ ____________________________________ Department / Function: _____________________________________________ Location: ________________________________________________________ Company: ________________________________________________________

9.

Pl give details of any illness / major surgery you may have suffered / undergone during last 5 yrs., requiring hospitalization / prolonged treatment. Nature of illness Period of hospitalization / treatment Name & Address of Hospital / Doctor

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10.

If appointment given will you be shifting your family to new location?

Yes If yes, give below details:

No

Shifting family members within________ (in months) which includes Sr. No. Name Relationship

11. References: Please give references of at least three persons who are not your relatives / friends. (at least, one professional and personal reference) Superior in previous org. Professional (e.g. Doctor/ lawyer /CA/Teacher etc. Superior in Current org.

Particular Name

Address

Occupation Mobile / Office Tel. E Mail Tel.No. (Resi.)

I hereby declare that the information and details furnished herein are true and complete to the best of my knowledge and belief. If any information is found to be suppressed, misrepresented or false, I shall be responsible for the resultant consequences and shall render myself liable to disciplinary action including termination of service without any compensation/ notice.

Place: _________________

Date: ______________ Signature: _________________

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Current Remuneration details:

Name:

Please give details of your current remuneration in the first blank column: Current Remuneration p.m p.a. Remuneration offer p.m. p.a.
For office use only

Details Fixed Basic Salary HRA Dearness Allowance Conveyance All. Children Edu. All. Canteen Allowance Other Allowance Any Other

Reimbursements

Retrals

Petrol Expenses Car Hiring Drivers Salary Entertainment Exp. Medical Reimb. Information Update LTA / LTC Any Other PF (Co.s Contri.) Superannuation Pension Gratuity Any Other Bonus Ex-gratia Performance Bonus Perf. Linked Incentive ESOP Any Other Total

Annual / Deferred Payments

Joining time required: ________________ Compensation Expected (Cost To Company): ________________________ (Per annum)
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