BEML Limited
( A Mini Ratna Company under Ministry of Defence, Govt. of India)
th
BEML Soudha, 23/1, 4 Main, Sampangirama Nagar, Bangalore-560027, Karnataka, India
Paste self attested
recent passport size
Photograph
APPLICATION FORM
(Advt No. KP/S/03/2015)
Post Applied For
In case of working in Govt/Quasi-Govt Organizations/ PSU, whether applied through proper channel:
Yes
No
Not applicable
If Yes, Please attach a copy of the forwarding letter of the employer or NOC to be produced at the time of Interview
1
2
Name of the Candidate
(in Block Letters)
__________________
(First Name)
__________________ __________________
(Middle Name)
(Last Name)
Male
Gender (please tick)
Female
Fathers / Husbands Name &
Address
Shri
Occupation
Communication Address
5 Telephone No. : Residential: .
Permanent Address
Office
Mobile: ..
6 E-Mail ID:
Date of Birth: - ./../.. ; Age as on 23.09.2015: .Yrs..Months....Days
DD
MM
YYYY
8 Nationality (by birth/ domicile) :
7. Religion :
9 Mother Tongue :
10. Marital Status:
Category (please tick)
11
12
Payment
Details (If
enclose the original challan )
OBC
SC
Sub Caste (mandatory)..
applicable,
Disabilities (PWD) if any
13
GEN
SC/ST/OBC category need to enclose the
caste certificate issued by the Competent
Authority as per Govt. of India
notification/guidelines.
If yes, mention (VH/OH/HH) and enclose
a copy of the PH certificate in the
prescribed format, issued by the
competent authority.
Branch Name & Code.
Journal No.
Yes
Date :
No
If Yes, mention (VH/OH/HH); Percentage of disability
ST
i.
14 Identification Marks
ii.
Whom to notify in case of emergency? Furnish name, relationship and full address(with Telephone no.)
15 Name:
Relationship:
Phone No.:
Address:
16. Family particulars:
Family Details
a)
b)
c)
d)
e)
f)
Name
Age & DOB
Place of
Birth
Employment Details
Solely
Dependent
(Y/N)
Nationality
Father
Mother
Spouse
Children 1
Children 2
________
17. EDUCATIONAL DETAILS
(Starting from Latest qualification acquired)
Degree/
Diploma
Name of the Institution /
University
Mode
(Re gular/Corre s pon
de nce /Part-tim e )
Years
Studied
% of Marks &
Year of Class / Division or Specialization /
passing
Equivalent
Branch of Engg.
grading
18. Practical Training and Apprenticeship Course
Name and Address of Institution
Nature of Training
Period
From
To
Membership of Professional Institution , if any:
19.
Sl No
Languages Known
Speak
Read
Write
a
b
c
d
EMPLOYMENT RECORD (Need to be supported by relieving letter at the time of joining)
Total Experience (yrs) :
Total post qualification Exp (yrs):
20. A. Current Employment
Designation
(a) Name & Address of Current Employer
(b). Complete Break-Up of Salary and Perks:(please enclose latest month Salary Slip)
From
DA
HRA
Spec. Allow. :
Any Other (please specify)
Duration (in yrs)
To
(c) Other Annual Benefits (please specify / enclose proof )
Scale of Pay :
Basic
Period
Annual CTC (All Inclusive):
B. Previous Employment (Starting from the latest)
Period
Name of the Employer
Designation
From
To
(dd/mm/yyyy)
(dd/mm/yyyy)
Duration
(in Years)
Break during employment (if any). Period & Reasons :
21. Other Information:
i. Where you in Govt. (Civil or Military) Service? if so, furnish details of service:
ii. Are you in receipt of any Pension either Military/Civil? if so, furnish amount of pension received:
Military :
Civil:
iii. State minimum basic pay acceptable to you :
iv. If selected, how soon would you be able to join duty?
v. Are you willing to serve in any part of India?
vi. Have you been candidate for any other post in this Organization? if so , furnish details :
vii. Have applied for appointment, scholarship elsewhere? If so give details:
viii.Do you hold any office of profit in business occupation or part-time employment? if so give details:
ix. Have you been convicted of any criminal offence?
x. Do you take part in Sports/Games/
Histrionics? if so, furnish Particulars:
xi. Relative in this Organization :
Name
Relationship
xii. Particulars of relatives residing outside India
Position & Place where employed
Name
Relationship
Country
xiii
Reference : Name position and address( not relative) holding responsible position not lower that the rank of
a Gazetted Officer and who knows the applicant personally.
(i)
xiv
(ii)
Any other information which you may wish to record may be furnished here.
DECLARATION
I hereby declare that the above statements are true & complete to the best of my knowledge and belief. In the
event of the information being found to be false or incorrect, my candidature / appointment may be cancelled
/terminated without any notice.
(Signature of the Candidate)
Place:
Date:
(Note : The candidate is required to fill up all the columns. Application will be rejected if any column is left
blank, not filled or incomplete. No correspondence in this regard will be entertained thereafter.)
