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2 WEF: 18th Sep, 2020
APPLICATION FORM
Please fill in the details with utmost attention, as these shall be ve rified by HiLabs and / or by its
authorized representatives.
All details are compulsory.
PERSONAL DETAILS
Name of Applicant: Surname Middle First
Kumar Ajay
Date of Birth (dd/mm/yy): 01/07/1992 Place of Birth: Morena, MP, India
Sex: Male Nationality: Indian
Father’s Name: Ram Baboo Singh Passport No/National ID Number.: Y6314047
Home Phone: Office Phone: Mobile: 9340042824
RESIDENTIAL ADDRESSES
PERMANENT ADDRESS:
RB HOUSE, IN FRONT OF H N 346, LIG-2, NEW HOUSING BOARD COLONY, MORENA, MP, INDIA
PIN: 476001
City: Morena State: Madhya Pradesh
Pin: 476001 Phone No.: 9340042824
✔ Own
Duration of Stay: From (mm/yy) To (mm/yy)
Nature of location: Rented Other (Specify)
CURRENT ADDRESS:
Silver Oak by Staybird, SN 5/2/3, opp. to Icon Bliss, behind Sai Srushti Society, Rakshak Nagar, Kharadi,
Pune, Maharashtra 411014
City: Pune State: Maharashtra
Pin: 411014 Phone No.: 9340042824
✔ Other (Hotel)
Duration of Stay: From (mm/yy) To (mm/yy)
26/03/2024 04/04/2024 Nature of location: Rented Own
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EDUCATION DETAILS
DATES
ATTENDED ROLL
NAME & NAME & ADDRESS OF COURSE
MARKS (%) NUMBER/
ADDRESS OF BOARD / UNIVERSITY ATTENDED YEAR
CGPA YEAR REGISTRATION
QUALIFICATION SCHOOL / TO WHICH THE SCHOOL / (FULL TIME/REGULAR,
OF
PART & PASSE NUMBER/
COLLEGE/ COLLEGE / INSTITUTE TIME/CORRESPONDENCE ENROL
CLASS D EXAM SEAT
INSTITUTE IS AFFILIATED TO ) MENT
(MM/YY) NUMBER
(MM/YY)
GRADUATION
DEGREE:
[Link].
IIT Bombay IIT Bombay FULL TIME 7.2/10 2011 2015 110020060
DISCIPLINE:
CHEMICAL
ENGINEERING
POST
GRADUATION
DEGREE:
DISCIPLINE:
ANY OTHER
REASONS FOR BREAKS IN EDUCATION: ______________________________________________________
____________________________________________________________________________________
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EMPLOYMENT RECORD: Starting with your present or most recent employer, please list last 3 employments. When listing
consulting or temporary assignments, under “Employer”, state the name of the consulting or temporary agency that placed you at
the client site. Complete and accurate dates (month/year) must be provided.
CURRENT EMPLOYER: Delivery Hero Employee Id: From (mm/yy): To (mm/yy):
632387 07/21 03/24
Street Address: Oranienburger Str. 70, 10117 Berlin, Germany Employer’s Fax No.:
Phone No.:
City: Berlin State: Berlin Country: Germany Postal Code: 10117
Job Title: Data Scientist Reason for Leaving: Moving back to India
Employment Status: (Please check the Supervisor’s Details:
relevant box) Name: Chandrakant Shendokar
Title: Team Lead
✔ Full Time
Contract /Through Outsourcing Agency Phone No.:
E-mail id:
Outsourcing Agency Details: (Preferably [Link]@[Link]
Name: official)
Address: HR Manager’s Details:
Tel No.: Name: Daria Manoilenko, Isha Bhatnagar
Description of Duties: Phone No.:
Leading Data Science efforts in E-mail id: [Link]@[Link]
Marketing Tech. (Preferably [Link]@[Link]
official)
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EMPLOYER 1: Tiger Analytics Employee Id: From (mm/yy): To (mm/yy):
01/20 04/21
Street Address: Prestige Tech Park, 1st floor Mercury Block, Employer’s Fax No.:
Kadubeesanahalli, Bengaluru, Karnataka, 560103 Phone No.:
City: Bengaluru State: Karnataka Country:India Postal Code: 560103
Job Title: Data Scientist Reason for Leaving: Moving abroad to Germany
Employment Status: (Please check the relevant Supervisor’s Details:
box) Name: Chiranjeev Malli
✔Full Time Title:
Contract /Through Outsourcing Agency Phone No.: 9778973788
E-mail id: [Link]@[Link]
Outsourcing Agency Details: (Preferably official)
Name: HR Manager’s Details:
Address: Name:
Tel No.:
Description of Duties: Phone No.:
Leading Data Science projects for clients E-mail id:
(Preferably official)
EMPLOYMENT RECORD CONTINUED:
EMPLOYER 2: Employee Id: From (mm/yy): To (mm/yy):
Galytix Analytics 01/19 01/20
Street Address: 17, Sector 44, Gurugram, Haryana 122003 Employer’s Fax No.:
Phone No.:
City: Gurugram State: Haryana Country:India Postal Code: 122003
Job Title: Jr. Data Scientist Reason for Leaving: Got new opportunity best fitting to me.
Employment Status: (Please check the relevant Supervisor’s Details:
box) Name: Raj Abrol
Title: CEO
✔Full Time
Contract /Through Outsourcing Agency Phone No.:
E-mail id: [Link]@[Link]
Outsourcing Agency Details: (Preferably official)
Name: HR Manager’s Details:
Address: Jan Tlaskal
Name:
Tel No.:
Description of Duties: Phone No.: Co-Founder
Helped Galytix to exploit data to create E-mail id: [Link]@[Link]
insights (Preferably official)
REASONS FOR BREAKS IN EMPLOYMENT HISTORY: ______________________________________________
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INFORMATION RELEASE AUTHORIZATION
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 disqualify me from employment and /or result in termination of employment.
I understand that HiLabs may request a verification of information provided by me and /or background check from an agency
hired by HiLabs for this purpose.
I further understand that the results of verification and checks and any records made out of that information will be used for
employment purposes only and will not be given to unauthorized persons.
I authorize HiLabs and/or its agents Pinkerton Corporate Risk Management India Pvt Ltd. to conduct a verification and
background check including but not limited to the verification and check of information and references stated by me in this
application for the consideration of HiLabs be used only for my employment purposes.
I give my consent to obtain my PAN/Passport/Voter ID and any other Government IDs to establish its genuineness. All such
verifications should be considered lawful processing and, I do not have any objection(s) around it.
If the Aadhaar is being requested by HiLabs as a proof of identity, I hereby state that I have no objection in authenticating
myself with Aadhaar based authentication system. I consent to submit voluntarily at my discretion, the physical copy of
Aadhaar card/physical e-Aadhaar/masked Aadhaar as issued by UIDAI (Aadhaar) to establish its genuineness through
acceptable manner as per UIDAI or under any Act or law from time to time.
I also understand that the information contained in my job application or otherwise disclosed by me will be stored and
processed only for verification for the applied employment. Pinkerton Corporate Risk Management India Pvt Ltd. will store
data provided by me for the period specified to the HiLabs.
I authorize UIDAI, EPFO, Law Enforcement Agencies, Learning Institutions (including Public and Private Schools and
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Universities), Information Service Bureaus, Credit Bureaus, Record/Data Repositories, Courts (Federal, State and Local),
Motor Vehicle Records Agencies, my past or present employers, and other individuals and sources to release the information
in their knowledge/possession/records relevant to my employment that is requested by Pinkerton Corporate Risk
Management India Pvt Ltd.
In the event that HiLabs and /or its agents are unable to verify any information and references stated in this application, it is
my responsibility to furnish the necessary documentation in support of that information.
“I fully understand that my personal information would move out of the geographical boundaries of the country I am
a resident of, in order to carry on with my verification process”.
I fully understand that this application or subsequent employment does not create a contract of employment nor guarantee
employment for any definite period of time and my employment decision will always be at the sole discretion of HiLabs
I have read, understood, and by my signature consent to these statements.
I authorize HiLabs to contact my present employer. ✔Yes No
SIGNATURE:
DATE: 28/03/2024
NAME (IN BLOCK LETTERS): AJAY KUMAR
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