CENTRAL U.P.
GAS LIMITED
Affix Recent (A joint venture of GAIL & BPCL)
Photograph KANPUR
PERSONAL DATA FORM
Position applied for _________________________________________________
1. First Name : __________________________Middle Name_____________________Surname_______________
2. Father’s /Husband’s Name : _________________________________________________________________________
3. Present Address :_____________________________________________________________________________________
_________________________________________________________________________________________________________
4. Contact No. ________________________________E-mail Id________________________________________________
5. Permanent Address: ________________________________________________________________________________
_________________________________________________________________________________________________________
6. Date of Birth : (DD/MM/YYYY)______________________________________________________________________
7. Marital Status: _______________________________________________________________________________________
8. Educational Qualification (High School Onwards) :
Sr. Examination Inst./Univ./Board Discipline/ Year of Percentage
No Specialization Passing (%)
9. Additional Qualification/ Trainings (Certified):
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10. Professional Membership(s):
11. Present Employer :______________________________________________________________________________
Nature of Business: ______________________________________________________________________________
Present / Last designation (effective date):____________________________________________________
Designation at the time of Joining: _____________________________________________________________
Date of Joining _______________________________No of Years:_______________________________________
Broadly outline job responsibilities & reporting relationship (i.e to whom you are
responsible and who all are reporting to you) along with organogram of your
organization
12. Past work experience:
Sr. Organization Nature of From To Years Designation
NO Business
13. Mention any other information which you think should be taken in to account in
considering your application for e.g Strength, weakness, reason for seeking change etc.
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14. Highlight any significant achievement you have implemented with any one of your past
employer(s).Indicated your initiatives which helped in reaching goal.
15. Present remunerations:
Particulars Amount
Basic & Allowance( Monthly)
Basic
DA
HRA
CCA
Conveyance
Telephone
Children Education
Special Allowance
Any other allowance( Please specify)
Gross Monthly Salary
Other Components
LTA
Medical
Bonus
Annual Incentive
Any other ( Please specify)
Retirement Benefits
P.F.
Gratuity
Superannuation
Total CTC
Additional Benefits /Perquisites
Loan (if any), Housing Loan, Vehicle Loan, Furnishing Loan, Personal advance, Medical
Advance, Any other (Please specify).
Total Annual CTC (Rs): _______________________________________________
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16. Reference (please give two references from your pervious organization in case of
fresher provide any two references).
1. _____________________________________________________________________________________________
______________________________________________________________________________________________
Tel. No./ Mobile : ________________________________________ Email Id: ______________________
2. ______________________________________________________________________________________________
______________________________________________________________________________________________
Tel. No./ Mobile : ________________________________________ Email Id: ______________________
17. Notice Period____________________________________ Willing to relocate:___________________
18. Salary Expected (CTC):______________________________________
Date :________________________ Signature (of the applicant)
Full Name :_________________________
Date:________________________ Signature (HR representative)
Full Name: _______________________________
Comments :
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