PROPEL INDUSTRIES PVT LTD

COIMBATORE - 641 401.

PERSONAL DATA FORM

* This form must filled - in by the candidate Recent Passport

* Attested / Xerox copies must be enclosed for proof of age, Educational Qualifications Size Photograph of
& other certificates / Testimonials the applicant Duly
attested by self

1. Name: Mr/Mrs/Ms
(In Block Letters)
2.b Mother 2 c. Spouse
2.a Father Name
Name: Name

3.a. Permanent Address b.Present Address

Pin Pin

c. Communication to be sent to: which address: Permanent Address / Present Address

Phone:
E-mail:

Aadhar No: PAN

4. a. Date of c. Age in Years : d. Place of Birth :
Birth : (As
b. Gender
per
Certificate)
e. Bank f. Bank Account
Name No:

g. Bank h. Nominee
IFSC Name

i. Nominee
j. Nationality k. Religion
Relationship

5. In case of Emergency Contact Person

b.
a. Name : Mr/Mrs/Ms
Relationship

c. Contact Number :

6 b. Blood
6. aMarks of Identification :
Group

7. a. Marital Status : Single / Married / Divorced / Widowed / Separated

b. Number of Dependants :

i) Children :

ii) Others :
8. Details of Family Members : (Parents / Husband/ Wife / Children / Brother / Sister

Marital Educational
Name Relationship Age in Yrs Occupation Salary Drawn / Month
Status Qualification

9. Languages Known : (State Mother Tongue First)

Language Speak Read Write Remarks

10. Educational Qualification: (SSLC Onwards)

Year Attended % of Marks

/ Grade /
Course Major Elective Name of University/College/Institution
Class
From To Obtained

11. Distinctions / Honours / Awards ( in academic fields)

12. School /Collegiate extra curricular activities :

13. Apprenticeship / Training

Period
Sl.No Name of the Organisation Stipend if Any
From To
14. Work Experience (should have supporting documents for the below)

Period Specific
Last Drawn Reason for
Sl.No Name of the Company Designation Achievements if
Salary Leaving
From To any

15. Period remained unemployed, if any :

16. a. Activities in community / civic or public affair

Activity No. of Years Position Held b. Your Hobbies / Interests

17. a. Have you any dis-inclination or disability limiting your field of work / ability to travel / reside in
any Part of India (If Yes, Please describe) Yes / No

b. i) Have you ever suffered from any contagious disease Yes / No

ii) If Yes, when & what disease :

c. Have you ever been prosecuted ? (Omit traffic violation) Yes / No

If Yes, case details :

18.Have you any objection to our making enquiries from your present Employer ? Yes / No

If Yes, clarify :

19. a. Have you been interviewed earlier by us or our Group ? Yes / No

If Yes, give details :

b. Are you member of EPF & ESIC Yes / No

i) If yes, UAN #: ii) ESI#:

c. Are you related / known to any employee of the company / Group ? Yes / No

If Yes, give details :

d. Is any of your close relatives or family members in business ? Yes / No

If Yes, relationship & nature of their business with Address :

e. Do you have your own business ? Yes / No

If Yes, give details :

f. Time required to join :

g. Any other information you wish to add :

20. Two references other than relatives

Phone
Sl.No Name Designation/Address
Number
No of years known

CERTIFICATION
I hereby certify as under:

That the foregoing information is correct and complete to the best of my knowledge and belief and nothing has been
concealed.
That, if at any time, I am found to have with held any material information or given any false declaration as detailed
above, my appointment shall be liable to summary termination without notice or compensation in lieu there of.
That in the course of my service, if appointed, I shall not involve myself with any other business / commercial / trade
activity either in my own name in conjunction with anyone else. Might it be a family member/s.

Place : KANGAYAMPALAYAM
Date : Signature of the Applicant
FOR OFFICE USE
Received in HR Dept on :
Verification of Proof of Age (SSLC Mark Sheet) / Educational Qualifications Testimonials / Experience certificates has
been done as per the standard checklist.

Date :
Signature of HR Dept. Official