Employment Application Form

If you have already registered on our IBM Job Portal please provide the IBM Candidate Applicant ID also called GOM
Candidate Applicant ID. If you are referred by an Agency, please ask your agency for the Applicant ID

IBM Application ID * C

FILL ALL DETAILS IN CAPITAL LETTERS Please affix your passport size photo here

*Title

* Enter your name as per your Passport, Driver's Licence, PAN Card or Or any Govt issued Photo Identity card (For Indian
Nationals)

*First Name / Given Name Middle Name

*Last Name / Family Name Father's Name

*Date of Birth *Mobile Number

DD MMM YYYY Country Code Mobile Number

*Personal Email ID Telephone (Landline)

Country Code City Code Phone Number

PAN Card Passport Number

Place of Issue of Passport Expiry Date

DD MMM YYYY

*Nationality Country Of Birth City Of Birth

*SOURCE INFORMATION - How did you know about this vacancy in IBM? (Select any one of the below)

Agency Enter Agency name

Employee Referrer's employee

Name of the
Referral Number
Employee
(Referrer Name)

Referrer's E- Mail ID Social Networks

(Website Name -Facebook/
LinkedIn/
Enter the jobsite Twitter/ Google+)
Job Site nam
e
here

Direct
Page 1 of 8, Employment Application form V 02, wef - 11th May 2015
 EDUCATION DETAILS (Fill in CAPITAL Letters)
Please complete all fields, even if you have already provided a resume. Provide details on COMPLETED degree programs only.

*Highest Qualification (Completed) ** e.g.: M.Sc, B.Com

**Highest completed degree / diploma awarded by a University / Board or its affiliates and or approved by UGC / AICTE / Ministry of HRD / Government of India

Name of the
Registration /
Complete Name & Address of School / College / Institution and Degree
Percentage/ Roll / Final
Qualification Course Tenure Name of the University Awarded
Grade Points Year Seat
*University name is mandatory where applicable(DO NOT ABBREVIATE) (e.g.. B.com /
Number
BA/ Mtech)

MMM YYYY School/

College/
Institution
Start Date
details (Name
& Address
End Date
SSLC (10th)
Year Of Passing University
Details (Name
& Address) if
applicable

MMM YYYY School/

College/
Institution
Start Date
details (Name
& Address
End Date
HSLC (12th)
Year Of Passing University
Details (Name
& Address) if
applicable

MMM YYYY School/

College/
Institution
Start Date
details (Name
& Address
End Date
Graduation
Year Of Passing University
Details (Name
& Address) if
applicable

MMM YYYY School/

College/
Institution
Start Date
details (Name
& Address
Post Graduation End Date

Year Of Passing University

Details (Name
& Address) if
applicable

Page 2 of 8, Employment Application form V 02, wef - 11th May 2015

EDUCATION DETAILS - contd. (Fill in CAPITAL Letters)

Name of the
Registration /
Complete Name & Address of School / College / Institution and Degree
Percentage/ Roll / Final
Qualification Course Tenure Name of the University Awarded
Grade Points Year Seat
*University name is mandatory where applicable(DO NOT ABBREVIATE) (e.g.. B.com /
Number
BA/ Mtech)

M M M Y Y Y Y
School/
College/
Institution
Start Date details (Name
& Address
Others -
End Date
PhD,
Additional
Degrees Year Of Passing University
Details (Name
& Address) if
applicable

State reasons for GAP in education, if any :

Professional Training (includes in progress degrees) - please mention the details

*Have you worked for IBM earlier? Yes No If "YES", please provide following details:

DATE OF
LAST WORKING DAY TYPE OF EMPLOYMENT EMPLOYEE NUMBER/
BUSINESS UNIT LOCATION JOINING MANAGER'S NAME
(DD-MMM-YYYY) (Regular/FTH/Contractor) CONTRACTOR CODE
(DD-MMM-YYYY)

*Are you willing to relocate as part

of your employment with IBM? If yes, please indicate
Yes No your preferences

*Consistent with IBM's policy on workforce diversity and in order to accommodate employee's
special needs in the work environment, please indicate if you are physically challenged Yes No ** IBM Corporation is an Equal Employment Opportunity Employer

If yes, please provide description of disability and

accommodation / assistance required:

*Do you have any non-compete obligations or conflict situations or other restrictive clauses with any
party including any of your previous employers that prevent you from working for IBM India Private Yes No
Limited?

Page 3 of 8, Employment Application form V 02, wef - 11th May 2015

 EMPLOYMENT HISTORY (FILL IN CAPITAL LETTERS)
Provide your last 3 (three) employment history. Also include information on self-employment. You can leave this page blank if you do not have prior work experience.

Employment Type
Serial Full Time /
Organisation Name and address (Permanent Tenure Employee Number
No Part Time
/Contractual)
Organisation Name *Most Recent Start Date

Address along with PIN Code End Date

01

Organisation Name Start Date

Address along with PIN Code End Date

02

Organisation Name Start Date

Address along with PIN Code End Date

03

Below is continuation of the above table. E.g. Continue to fill in details of "Serial No 1" (Above) in "Serial No 1-Continue" row below.

Serial Reporting Manager's Name If Employment Type is Contractual, Please Provide Outsourcing Agency Name,
Designation Reasons for Leaving
No and contact number)* Complete Address and Contact Number

Organisation Name Complete Address

01
Pin Code Contact Number

Organisation Name Complete Address

02
Pin Code Contact Number 009876533

Organisation Name Complete Address

03
Pin Code Contact Number
*Current Reporting Manager will be contacted ONLY AFTER the candidate joins IBM
Total years of experience - (please do not include any State GAP in
Years Months
training or internship experience) Employment if any:

Page 4 of 8, Employment Application form V 02, wef - 11th May 2015

OTHER DETAILS (Fill in CAPITAL Letters)

Current Annual Remuneration/ Cost to company

If you are related to IBM India Private Limited employees and/or Directors (sibling / spouse/ children/in law relationships), please provide names and relationship.

Name Designation Business Unit Relationship

*Have you ever been convicted? Are criminal charges pending against you? Yes No If yes state the offence

*Have you worked for the Government, whether as a civilian employee or member of the Yes No
military?
All Candidates must indicate if they have worked for the Government, whether as a civilian employee or member of the military. If so, you must also indicate whether you had any
responsibilities or were involved in activities relating to IBM or an affiliated Company. You must also state whether you are aware of any legal restrictions on what work you may do for IBM
or an affiliated Company, and if so, what those restrictions are.

Name of Government Organization and Department

Tenure

Job Responsibilities

Restrictions (if any)

DECLARATIONS
Source Declaration
1. If applicable, I hereby confirm that in my duties as a government employee, I have (or have had) no
matters involving IBM (in any capacity whatsoever), or if I do, that I have officially withdrawn from By submitting the IBM Employee Referral name I confirm that the referrer is known to me personally or
participating in those matters while I am discussing potential employment with IBM. All details of any professionally. This relationship may be a result on account of participation in various social networks which
such matters that I have been involved with, where IBM or any of its affiliates have been involved, are are either formal (examples of formal networks are Linkedin, Facebook, Twitter, industry and competency
listed above. associations) or informal (examples of informal networks are former employment with the same company,
2. I confirm that the information provided by me in this application form is complete and accurate. friends circle, alumni from same educational institution or study circles) .
3. I understand that if any information provided by me with respect to my application for employment is
found to be untrue, inaccurate or misleading, IBM INDIA Private Limited may withdraw any offer of I also confirm that the referrer has made me aware that by referring my candidature to IBM for an opportunity
employment made to me or terminate my employment (If I have already joined IBM India) without notice. of employment, he/she may be eligible to receive a referral bonus.
3. I understand that all the details provided in this application are subject to verification.
4. I hereby authorize IBM India Private Limited and its representatives (including reference check
agencies/third party vendors) to verify information provided in my application for employment and to
conduct enquiries as deemed necessary by the company.

*Date
*Signature *Place (DD-MMM-
Enter full name YYYY)

Page 5 of 8, Employment Application form V 02, wef - 11th May 2015

 BACKGROUND CHECK APPLICATION FORM - I

Last Name Middle Name First Name

Date of Birth Gender Nationality Passport No:

Father's Name IBM GOM Code / IBM Employee ID

Social Security # / National Insurance # Proof of name change attached if applicable Yes No

EDUCATION (Please mention only highest completed education as declared in Employment Application Form)
Also indicate Specialization of the Degree/
Name of Degree / Diploma Diploma
*Name & Location of School/College/Institute
From MMM / YYYY To MMM / YYYY
(also mention whether course attended is Dates
Regular/correspondence) attended
Name & Location of university to which the From MMM / YYYY
college/Institute is affiliated to Year of
passing
Roll Number / Registration Number / Exam Seat
Number

Note : If you are a Fresher, please specify " NA" in all the fields below.

EMPLOYMENT RECORD: Starting with your present or most recent employer, please list last 3 employments in chronological order. When listing consulting or temporary assignments under "Employer", state the
name of the consulting or temporary agency that placed you at the client site

CURRENT / MOST Job Title

From
RECENT EMPLOYER
(Company Name) To Employee ID :

Complete Address Reason for Employment status (Permanent /Contractual)

Leaving :

OUTSOURCING AGENCY DETAILS

Name Pin code

Full Address

PREVIOUS EMPLOYER
------------------
(PRIOR TO THE MOST Job Title
RECENT (Company Name) From
To Employee ID

Complete Address Reason for

Leaving Employment status (Permanent /Contractual)

OUTSOURCING AGENCY DETAILS

Name Pin code

Full Address

Page 6 of 8, Employment Application form V 02, wef - 11th May 2015

 BACKGROUND CHECK APPLICATION FORM - I contd.

SECOND PREVIOUS
From Job Title
EMPLOYER (Company
Name)
To Employee ID

Complete Address Reason for

Leaving Employment status (Permanent /Contractual)

OUTSOURCING AGENCY DETAILS

Name Pin code

Full Address

INFORMATION RELEASE AUTHORIZATION ( TO BE SIGNED BY THE CANDIDATE)

I certify that the statements made in this application are valid and complete to the best of my knowledge. I understand that false or misleading information may result in termination of employment.
If upon investigations, any of this information is found to be incomplete or inaccurate, I understand that I will be subject to dismissal at any time during my employment. I hereby authorize IBM and /or any of its
subsidaries or affiliates, and any persons or organizations acting on its behalf to verify the information presented on this application form and to procure an investigative report or consumer report for that purpose. I
hereby grant authority for the bearer of this letter to access or be provided with full details of my previous records.
In addition, please provide any other pertinent information requested by the individuals presenting this authority. I hereby release from liability all persons or I authorize to contact my present
employer I have read, understand and by my signature consent to these statements.

*Signature Enter full name *Date *Place

Page 7 of 8, Employment Application form V 02, wef - 11th May 2015
 BACKGROUND CHECK APPLICATION FORM - II

Last Name
Middle Name First Name

Date of birth Gender Nationality

Father's Name IBM GOM

Passport Number
Code / IBM
Employee ID

*Current Address Permanent Address (Please fill only if different from the current address)

* House/Flat No. * House/Flat No.

* Street (Cross & * Street (Cross &

Main) Main)

* Nearest
* Nearest LandMark
LandMark

* City * State * City * State

*PIN Code *Country *PIN Code *Country

Point of Reference# along with Contact details Point of Reference# along with Contact details
Name of the contact Name of the
person contact person

Phone Number Phone Number

* Present Address: Address where your are currently staying

** Permanent Address: Address where you are permanently residing, irrespective of Present address. This is typically your parent’s residence or an address in your home town.
# Reference: Could be your Parents, Spouse, Neighbours, Friends, Relatives, Room mate who stayed with you etc. or staying in close neighborhood.

INFORMATION RELEASE AUTHORIZATION ( TO BE SIGNED BY THE CANDIDATE)

I certify that the statements made in this application are valid and complete to the best of my knowledge. I understand that false or misleading information may result in termination of
employment. If upon investigations, any of this information is found to be incomplete or inaccurate, I understand that I will be subject to dismissal at any time during my employment. I hereby
authorize IBM and /or any of its subsidaries or affiliates, and any persons or organizations acting on its behalf to verify the information presented on this application form and to procure an
investigative report or consumer report for that purpose. I hereby grant authority for the bearer of this letter to access or be provided with full details of my previous records. In addition, please
provide any other pertinent information requested by the individuals presenting this authority. I hereby release from liability all persons or I authorize to contact my present employer.

I have read, understand and by my signature consent to these statements.

*Signature
Enter full name *Date
(DD-MMM-YYYY) *Place

Page 8 of 8, Employment Application form V 02, wef - 11th May 2015