PRIVATE & CONFIDENTIAL

MAJULAH INFOTECH PRIVATE LIMITED

formerly known as “MAJULAH SYSTEMS PRIVATE LIMITED”
Tek Meadows, Ground Floor, Tower B
No 51 Rajiv Gandhi Salai (OMR)
Sholinganallur, Chennai
Tamil Nadu 600119

EMPLOYMENT RECORD

Position :

Source of Application (Referral/Job Portal)

A. Personal Particulars

Salutation : Mr / Ms / Mdm Full Name :

Current Address: Postal Code :

Permanent Address (Native) Postal Code:

Country of Residence : Citizenship :

NRIC / Passport No /AADHAR No : Gender : Marital Status :

Country of Birth : Date of Birth: Religion:

Contact No: Email:

Emergency Contact Emergency Blood Group:
Person (Name/Relationship): Contact Number:

Years of Relevant Experience :

B. Family Information

Name Relationship Contact Occupation

C. Employment History

Start Date End Date Monthly

Company Position Reasons for Leaving
(mm/yy) (mm/yy) Salary

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Majulah Infotech Private Limited is a wholly owned subsidiary of Info-Tech Systems Integrators Private Limited.
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D. Academic Qualifications

Start Date End Date

School / College / Polytechnic / University / Institution Highest Qualification Attained
(mm/yy) (mm/yy)

E. Declarations

Have you ever been arrested for, or been charged with any criminal offence within or outside of India,
Yes No
or held by any law enforcement agencies for violation of any laws?

Have you ever been subjected to, convicted of, or adjudged liable in any disciplinary, criminal, civil or
other proceedings in respect of any matter, offence or breach of duty involving fraud, dishonesty or
Yes No
deceit (including abetting any third party in respect of any such matter, offence or breach of duty)
within our outside of India?

Are you an undischarged bankrupt as of today? Yes No

Have you ever been terminated, dismissed or retrenched in any of your previous employment? Yes No

Have you ever been refused entry into or been deported from any country? Yes No

Have you ever been convicted in a court of law in any country? Yes No

Have you, within the last 5 years, suffered from any illness or conditions which had affected your ability
Yes No
to work?

Do you have any medical condition(s) or concern which will affect your ability to perform the role
Yes No
applied for, that we should be aware of?

If you had answered “Yes” to any of the above questions, please elaborate here: _________________________________________

________________________________________________________________________________________________

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Majulah Infotech Private Limited is a wholly owned subsidiary of Info-Tech Systems Integrators Private Limited.
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F. References (Professional)
As part of the hiring process, please furnish us with at least 2 previous employers for reference check. These references should have
either supervised you in the past and/or are of managerial level. Kindly note that the referees provided must be non-relatives and/or
family members and that you have obtained their consent to be contacted by Majulah Infotech Private Limited in the event of successful
shortlisting.

Name Title Company Contact Number

G. Acknowledgement
I understand that misrepresentation or omission of facts calls for dismissal and I will be required to produce original documentation to
verify my employment eligibility. I also understand that I must successfully complete a company administered medical examination (if
required) as a condition of employment. I consent Majulah Infotech Private Limited and/or any appointed agent to make reference checks
from my previous employers.

Employee’s Signature : ______________________________ Date : ________________________________

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Majulah Infotech Private Limited is a wholly owned subsidiary of Info-Tech Systems Integrators Private Limited.