PERSONAL DETAILS Name of Applicant !andator"# ASHISH SRIVASTAVA S!name !andator"# SRIVASTAVA "iddle !andator"# #i!$t !andator"# ASHISH "aiden Name : % Ha&e yo e&e! 'een (no)n 'y anot*e! name+ NO Place of Birt$% L,C-NO.# Date of Birt$ /0012AN103405 Se6: "ALE Nationality: Indian #at*e!7$ Name !andator"# A8C8SRIVASTAVA 9a$$po!t No8 HO653::3 SSN No8 /"andato!y ;o! ,S add!e$$5 Home 9*one O;;ice 9*one "o'ile : 3354033333 Email id% a$*i$*<telecom=>mail8com Permanent Addre&& %' 1516, Vidhi Tower, Mahagunpuram, NH-24, near Columbia Asia Hospial, !ha"iabad, #$ %$ - 2&1&&2 Same% 1516, Vidhi Tower, Mahagunpuram, NH-24, near Columbia Asia Hospial, !ha"iabad, #$ %$ - 2&1&&2 City : ?HA@IAAAD State : ,89 9in Code : B0000B Nea!e$t Landma!( : near Columbia Asia Hospial Name o; t*e contact pe!$on at t*e add!e$$ : HE"A SRIVASTAVA Relation$*ip o; contact pe!$on : .I#E Landline No8 "o'ile No8 3B64B45<66 Nat!e O; Location: O)ned 9!e;e!!ed time o; t*e day ;o! condctin> t*e &e!i;icationC i; any : AND TI"E Re$idin> Since /"andato!y5: B003 Re$idin> Till / "andato!y5:Till Date ED()ATION RE)ORD ED()ATION RE)ORD (Start with the latest/ highest qualification; please attach photocopies of the documents ) All fields are mandatory Name & Address of School/College /Institute Name & Address of ni!ersity its affiliated "ype of #egree/#ipl oma o$tained% State &'( for fulltime and &)( for part*time within $rac+ets #ates Attended 'rom "o ,oll Num$er/,egis tration Num$er/-.am Seat num$er HIMT, Greater Noida HI"TC Greater Noida, Affiliated to U.P.T.U, Lucknow "CA/#5 2,LD B003 2,NE B006 030330<00B ?8N8L8D Ra$to>i Inte! Colle>e Alla*a'ad Aoa!d Inte!mediate/ #5 2ly 0335 2ne 033: 3B4:6< "8A8V Inte! Colle>e Alla*a'ad Aoa!d Hi>*Sc*ool /#5 2ly 0333 2ne 0335 5030B< E!PLO*!ENT RE)ORD If you are still employed in this organi/ation0 please fill in the date $efore which you would not li+e the !erification to $e initiated in the &"o( column% If you are not sure or would li+e to intimate this date later0 please write 1Still -mployed1 -mployer 2 Full Name Emplo"ee ID From mm+""# To mm+""# Add!e$$ C%B< C SEC E 53 C NOIDA P$one Num,er City NOIDA State ,89 Cont!y India 9o$tal Code B00300 2o' TitleF TECHNICAL O9ERATION ANALDST Rea$on o; Lea&in>: Sala!y De&ignation So;t)a!e De&elope! #inal Sala!y /Annal CTC5 Super-i&or Name . Title /R !anager Name Super-i&or 0& P$one Num,er /R !anager P$one Num,er E!PLO*!ENT RE)ORD -mployer 3 Full Name Emplo"ee ID From mm+""# To mm+""# Add!e$$ P$one Num,er City State Cont!y India 9o$tal Code 2o' Title Rea$on o; Lea&in> Contact 2o' De&ignation #inal Sala!y /Annal CTC5 Super-i&or Name . Title /R !anager Name Super-i&or 0& P$one Num,er /R !anager P$one Num,er E!PLO*!ENT RE)ORD -mployer 4 Full Name Emplo"ee ID From mm+""# To mm+""# Add!e$$ P$one Num,er City State Cont!y 9o$tal Code 2o' Title Rea$on o; Lea&in> De&ignation #inal Sala!y /Annal CTC5 Super-i&or Name . Title /R !anager Name Super-i&or 0& P$one Num,er /R !anager P$one Num,er E!PLO*!ENT RE)ORD -mployer 5 Full Name Emplo"ee ID From mm+""# To mm+""# Add!e$$ P$one Num,er City State Cont!y 9o$tal Code 2o' Title Rea$on o; Lea&in> De&ignation #inal Sala!y /Annal CTC5 Super-i&or Name . Title /R !anager Name Super-i&or 0& P$one Num,er /R !anager P$one Num,er E!PLO*!ENT RE)ORD -mployer 6 Full Name Emplo"ee ID From mm+""# To mm+""# Add!e$$ P$one Num,er City State Cont!y 9o$tal Code 2o' Title Rea$on o; Lea&in> De&ignation #inal Sala!y /Annal CTC5 Super-i&or Name . Title /R !anager Name Super-i&or 0& P$one Num,er /R !anager P$one Num,er E!PLO*!ENT RE)ORD -mployer 7 Full Name Emplo"ee ID From mm+""# To mm+""# Add!e$$ P$one Num,er City State Cont!y 9o$tal Code 2o' Title Rea$on o; Lea&in> De&ignation #inal Sala!y /Annal CTC5 Super-i&or Name . Title /R !anager Name Super-i&or 0& P$one Num,er /R !anager P$one Num,er REFEREN)E VERIFI)ATION REFEREN)E VERIFI)ATION Note E T*e !e;e!ence p!o&ided $*old 'e c!!ently employed o! en>a>ed in a p!o;e$$ional acti&ity8 11Plea&e en&ure t$at t$e contact num,er& of t$e reference are acti-e num,er& and are reac$a,le for -erification REFERENCE (1) (1)Full name of the Reference (professional) Telephone # and email ID Organization Relationship with the candidate Friend REFERENCE (2) (1)Full name of the Reference (professional) Telephone # and email ID Organization Relationship with the candidate REFERENCE (3) (1)Full name of the Reference (professional) Telephone # and email ID Organization Relationship with the candidate Information Relea&e Form To 2$om It !a" )oncern% 9lea$e p!int Sa*GGGGGGGGGGGGGGGGGGGGG GGGGGGGGGGGGGGGG La$t name #i!$t name "iddle name I *e!e'y at*o!iHe Vendo! o! t*ei! !ep!e$entati&e$ to &e!i;y in;o!mation p!e$ented on my employment application1!e$me and to p!oc!e an in&e$ti>ati&e !epo!t o! con$me! !epo!t ;o! t*at p!po$e8 I *e!e'y >!ant at*o!ity ;o! t*e 'ea!e! o; t*i$ lette! to acce$$ o! 'e p!o&ided )it* ;ll detail$ n o; my p!e&io$ employment !eco!d *eld 'y any company o! '$ine$$ ;o! )*om I p!e&io$ly )o!(ed8 T*i$ in;o!mation $*old inclde t*e date$ o; employmentF t*e nat!e o; t*e po$ition *eldC Idetail$ o; my $ala!y pon depa!t!eJ and an app!ai$al o; my pe!;o!manceC capa'ilitie$ and c*a!acte!8 In additionC plea$e p!o&ide any ot*e! pe!tinent in;o!mation !eKe$ted 'y t*e indi&idal p!e$entin> t*i$ at*o!ity8 I *e!e'y !elea$e ;!om lia'ility all pe!$on$ o! entitie$ !eKe$tin> o! $pplyin> $c* in;o!mation8 n o; my Kali;ication1de>!ee /copy o; my ce!ti;icate$ attac*ed5 n in;o!mation in !e$pect to my c*a!acte! ;!om t*e !eco!d$ maintained 'y local at*o!itie$
Si>nat!e: Date:
Checklist For Education Verification: Clear cop of the degree certificate and final ear mar! sheet would "e re#uired For Bangalore Uniersit!: $ clear photo cop of "oth sides of the Degree Certificate (The re%erse side of the certificate has some information which the uni%ersit would re#uire) Copies of the &ar! 'heets()rade Card for all the ears of attendance* +ame of the college through which the candidate has graduated* For E"#lo!"ent Verification: Clear ,hotocop of the relie%ing(e-perience certificates .mploee Code of the organization where%er a%aila"le For Cri"inal Verification $uthorization letter dul signed " the candidate/ authorizing a third part to conduct a criminal %erification* &andator Re#uirement 0ist for Criminal 1erification* Common &andator Re#uirement for all locations 1) ,hoto identit proof (2e would re#uire an one of the "elow mentioned documents*) ,assport cop (First/ &iddle and last page) ,an card 1oter3s identit card Dri%ing 0icense 4) $ddress proof (2e would re#uire an one of the "elow mentioned documents) Clear Ration card cop (First/ &iddle and last page) ,assport Cop (First/ &iddle and last page) &T+0(5'.' "ill clearl stating the address/ wherein the %erification needs to "e conducted $ttested cop of 0ea%e and 0icense agreement ($ll pages) 0etter from compan clearl specifing the permanent address 6ostel $ccommodation 7 $ttested cop confirming the current address on the 6ostel letterhead* ,aing )uest $ccommodation 7 $ttested letter " the secretar or chairman of the societ on a societ letterhead 8) Residing with a Friend 7 $ttested cop of the friends lea%e and license agreement 9 attested cop issued " the Friend confirming the candidates address details :) Contact details of the su";ect would "e re#uired* For Cri"inal Background Verification $s is the process followed " most of the police departments across India for criminal "ac!ground %erification/ it is possi"le that the police authorities ma contact ou or %isit our stated residence and at times e%en as! ou to present ourself at the concerned police station* It is part of the standard %erification procedure ,lease do not gi%e in to an attempts at coercion " the authorities and in the e%ent of an occurrence/ please inform our respecti%e human resource officials immediatel*