Employment Data Form

Please affix recent passport size photograph

Name: ______________________________________________________________________ (Surname) (First name) (Middle name)

Position applied for Name of the Group Company / Business Function Location

: : : :

Page 1 of 8

A.

Personal data
1. 2. 3. 4. Name: Place of Birth: _____________________________ Date of Birth: ______________________ Blood Group: Present Address Permanent Address

5. 6. 7. 8. 9.

Telephone No: (M)_______________ Landline: Office_____________ Resi._______________ E-mail Address: _______________________________________________________________ Permanent Account Number: ____________________________________________________ Passport Number: __________________________ Valid up to: ________________________ Nationality: ___________________________________________________________________ State of origin: _____________________ State of domicile: ___________________ Since: _________ yrs.

10. Domicile Details: (Indian Nationals)

12. Identification Mark: ___________________________________________________________ 13. Religion: _____________________________________________________________________ 14. Category: _______________ General ST SC OBC Other

15. Marital Status: ______________________ 16. Details of family members

D at e O f Sr. No. Na me R e la t ion sh ip Birth Occupat ion N am e Of Em p loye r Dep end en t Ye s / No

1 2 3 4 5

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15. Languages Known:

Mother Tongue: Regional / Vernacular / Other

Hindi

English

Pl. mention:

________ Read: Speak: Write: 16. Hobbies & Interests: 17. Extra-curricular activities:

________

________

18. Please mention physical challenges, if any ___________________________________________

B. Education and training

1. Educational Record: (starting with SSC/ equivalent).
Please mention PT for part-time and DL for distance learning courses in the second column

Sr. No.

Degree/Diploma Certificate

Year of Passing

School/College Board/University

No. of Attempts

Duration of course

Principal Subjects

Percentage / Grade

2. Specialized Training / Certification/s: Sr. No. Institute / Organisation Name of Course / Certificate Period From To Subject(s)
Percentage/ Grade

3. Details of membership in professional bodies / institutions: Sr. No. Institute / Organization Type of membership Remarks

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C. Employment History
1. Particulars of employment (starting from current employer): Period of Service To From
(dd/mm/yy) (dd/mm/yy)

Designation Initial Last

Name & Location of employer

Broad / Major Responsibilities

Please use additional sheets if required. Please give your current remuneration details on the last page of this form.

2. Your present job responsibilities: _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ ___________________________________________________ 3. Present organisation structure:

Kindly circle your position and indicate your reporting relationship i.e. person to whom you report and who reports to you. Page 4 of 8

D. General Information:
1. Significant achievements: distinctions/ honor/ awards received / Books / Papers published Year Details

2. What, according to you, are your strengths and areas for improvement?: Strengths:

Areas for improvement:

3. Reason for contemplating a change from the present job.

4. Reason for seeking appointment in the Adani Group

5. Any other information you would like to offer, including other / personal details / special achievements, if any

6. Are you prepared to relocate to any of our businesses / locations in India / Abroad? Yes No Page 5 of 8

7.

Are you related to any employee / associate of Adani Group? Yes If yes, give details below: No

Name(s)

:___________________________________________________________

Company /Business & Location: __________________________________________ Department: ____________________________________________________________ Designation: ____________________________________________________________ Nature of Relationship/Acquaintance: ___________________________________________ Note: Please furnish full details of all persons related or known to you. Attach/use additional sheet if required.

8.

Have you been interviewed by us / any of our group companies in the past? Yes No

If yes, give below details Position: _________________________________________________________ Department / Function: _____________________________________________ Location: ________________________________________________________ Company: ________________________________________________________

9.

Pl give details of any illness / major surgery you may have suffered / undergone during last 5 yrs., requiring hospitalization / prolonged treatment. Nature of illness Period of hospitalization / treatment Name & Address of Hospital / Doctor

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10.

References:

Please give references of at least three persons who are not your relatives / friends. (at least, one professional and personal reference) Name Address

Occupation: Mobile / Office Tel. E Mail Tel. No. (Resi.)

I hereby declare that the information and details furnished herein are true and complete to the best of my knowledge and belief. If any information is found to be suppressed, misrepresented or false, I shall be responsible for the resultant consequences and shall render myself liable to disciplinary action including termination of service without any compensation/ notice.

Place: __________________ Date: _________________ Signature: _________________

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Current Remuneration details:

Name:

_______________________________

Please give details of your current remuneration in the first blank column: Details Fixed Basic Salary House Rent Allowance Dearness Allowance Conveyance All. Children Edu. All. Canteen Allowance Other Allowance Any Other Current Remuneration p.m p.a. For office use only Remuneration offer p.m. p.a.

Reimbursements

Petrol Expenses Car Hiring Drivers Salary Entertainment Exp. Medical Reimb. Information Update LTA / LTC Any Other PF (Co.s Contri.) Superannuation Pension Gratuity Any Other Bonus Ex-gratia Performance Bonus Perf. Linked Incentive ESOP Any Other

Retirals

Annual / Deferred Payments

Compensation Expected (Cost To Company): Rs. ___________________ (Per annum)

Joining time required: ___________________________ Page 8 of 8