EMPLOYMENT APPLICATION FORM

AFFIX YOUR
RECENT
PHOTOGRAPH

POST APPLIED FOR ________________________

SIGNATURE OF THE APPLICANT

1. NAME (IN BLOCK LETTERS): _________________________________________________________

2. FATHER’
S/HUSBAND’
S NAME: ________________________________________________________

3. MOTHER’
S NAME: ___________________________________________________________________

4. PRESENT ADDRESS:
_____________________________________________________________________________________

____________________________________________________________________________________________________________

TELEPHONE NO:

MOBILE NO:

E-MAIL ADDRESS:_______________________________________________________________________________________
(Application without complete contact details will not be accepted)
5. PERMANENT ADDRESS:
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________

TELEPHONE NO:

6. DATE OF BIRTH: (DD/MM/YYYY):

7. AGE ON DATE: YEAR MONTH DAY

8. PLACE OF BIRTH: __________________________________________________________________

9. NATIONALITY: ____________________________________________________________________

10. MARITAL STATUS: SINGLE/ MARRIED 11.GENDER: MALE/FEMALE

12. CASTE: _________________________ 13. RELIGION: __________________________

CORPORATE OFFICE
SECURITY & INTELLIGENCE SERVICES (INDIA) LTD, A-28 & 29, Phase I Okhla Industrial Area, New Delhi -110 020, India, Phone No: - 011-32607510/32454030/46523900.

ADMINISTRATIVE OFFICE
SECURITY & INTELLIGENCE SERVICES (INDIA) LTD, Administrative Office, Nishant Regency, Frazer Road, Patna-800001 Phone No: - 0612-3257526/27/29.
 14. PHYSICAL MEASUREMENT:

HEIGHT (in cm.) WEIGHT (in kg.) CHEST

NORMAL (in cm.) EXPANSION (in cm.)

15. IDENTIFICATION MARK: _____________________________________________________

16. HEALTH DECLARATION:

Do you have or have you ever had Do you have or have you ever had
Yes / Yes / No
any of the following: any of the following:
No
1. Any serious infectious diseases? 19. Joint problem?

2. Any stomach problem? 20. Back problem?

3. Bowel problem? 21. Depression?

4. Asthma? 22. Mental illness?

5. Tuberculosis? 23. Are you diabetic?

6. Any other chest problem? 24. Hypertension (BP)?

7. Any allergy? 25. Any disability?

8. Fainting? 26. Anemia?

9. Blackouts? 27. Arthritis?

10. Epilepsy? 28. Hepatitis?

11. Ear problems? 29. Tetanus?

12. Hearing defect? 30. Ulcers?

13. Dermatitis or eczema? 31. Sexually transmitted diseases?

14. Any other skin problem? 32. Measles?

15. Cancer? 33. Meningitis?

16. Any heart problem? 34. Any liver problem?

17. Any kidney problem? 35. Glaucoma?

18. Any Lungs problem? 36. Any other eye ailments (Chronic)?

Details of Hospitalization during last 10 Years: _______________________________

____________________________________________________________________

Vision: (with glasses) R______ L_____ (without glasses) R_____ L______

17. FAMILY DETAILS:

SI. MARITAL
NAME RELATION AGE OCCUPATION
NO. STATUS
18. EDUCATIONAL QUALIFICATIONS:

NAME OF THE NAME OF THE YEAR OF SUBJECTS STUDIED DIV / CLASS

EXAMINATION S BOARD/UNIVERSITY PASSING PERCENTAGE
(

19. CURRENT EMPLOYMENT:

(A) NAME & ADDRESS OF PRESENT EMPLOYER
_________________________________________________________________________________

(B) EMPLOYED SINCE _________________________________________________________________

(C) PRESENT DESIGNATION & SUMMARIZED DESCRIPTION ___________________________________

___________________________________________________________________________________

(D)FOR EXTERNAL CANDIDATES ONLY

PRESENT ANNUAL GROSS SALARY (IN RS.) EXPECTED ANNUAL GROSS SALARY (IN RS.)

___________________________________________________________________________________
OTHER BENEFITS:
___________________________________________________________________________________
REASON FOR WANTING TO LEAVE:
___________________________________________________________________________________

(E) FOR INTERNAL CANDIDATES ONLY

(1) BAND (BANDED/ UNBANDED)

___________________________________________________________________________________
(2) RANK / DESIGNATION
___________________________________________________________________________________
(3) MENTION AWARDS & CERTIFICATE OF APPRECIATION RERCEIVED DURING YOUR EMPLOYEMENT
WITH SIS. _________________________________________________________________________

(F) 1) WHOM DO YOU REPORT TO?

___________________________________________________________________________________
2) WHO REPORTS TO YOU? ________________________________________________________

20. (A) CAN YOU TYPE: YES/NO IF SO AT WHAT SPEED (WPM) _______________________________
(B) COMPUTER SKILLS MS- OFFICE: YES/NO OTHERS: _______________________________

21. Language (Mention level of competence) _______________________________________

Level 1: Rudimentary Level 2: Limited Knowledge

Level 3: Good Working Knowledge Level 4: Fluency
Level 5: Interpreter
22. PREVIOUS EMPLOYMENTS: Provide details of all position with your present employment
going back to the first in the space below: (Please use additional sheets if more space is required).

EMPLOYER’
S TITLE PERIOD WORKED KEY REASON FOR
NAME RESPONSIBILITIES LEAVING
& ADDRESS

23. Demonstrate suitability for the position applied for:

_____________________________________________________________________________

_____________________________________________________________________________

24. ARE YOU RELATED / KNOWN TO ANY OF THE PRESENT EMPLOYEE OF SIS? YES /NO

IF YES, TO WHOM? DESCEIBE RELATIONSHIP

25. HAVE YOU BEEN EARLIER INTERVIEWED BY SIS? IF YES, FOR WHICH POST AND WHEN?

26. HAVE YOU EVER WORKED FOR SIS IF YES DESCRIBE THE PERIOD & REASON FOR LEAVING?

27. HAVE YOU EVER WORKED FOR ANY SECURITY SERVICE PROVIDER BEFORE? IF YES, GIVE
DETAILS:

28. IF SELECTED HOW MUCH TIME WOULD YOU REQUIRE TO JOIN?

29. REFERENCE DETAILS:

NAME & DESIGNATION OCCUPATION ADDRESS CONTACT NO.

30: DECLARATION
I CERTIFY THAT THE PARTICULARS MENTIONED IN THE FORM ARE CORRECT TO THE BEST OF MY KNOWLEDGE AND
BELIEF, IN CASE ANY INFORMATION PROVIDED IS FOUND FACTUALLY INCORRECT MY SERVICES ARE LIABLE TO
BE TERMINATED WITHOUT ASSIGNING ANY REASON.

PLACE:
DATE: SIGNATURE:

FOR OFFICIAL USE

RECEIVED STAMP: HR DIVISION

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