RELIANCE GROUP OF COMPANIES

HR DEPARTMENT
Reliance Corporate Park,
Building Number TC23, D Wing, 7th Floor,
Phase IV, Reliance Corporate Park,
Thane Belapur Road,
Ghansoli, Navi Mumbai 400 701.
CONFIDENTIAL
AFFIX
PHOTOGRAPH
HERE

PERSONAL HISTORY FORM

POSITION APPLIED:
YOU CAN JOIN BY:

AA.

PERSONAL & FAMILY BACKGROUND

01.

FULL NAME:
02.
`DATE OF BIRTH:
PLACE OF BIRTH:
NATIONALITY:
GENDER: MALE

FEMALE
03

YOUR WEIGHT: KGS.

YOUR HEIGHT: CMS.
04.
YOUR EYESIGHT:
Left eye: Right eye:
BLOOD GROUP:
RH VE
05.
IDENTIFICATION MARKS (If any)

06.
PAN CARD:
BANK A/C (Only ICICI/HDFC/SBI):

Label1
07.
PRESENT MAILING ADDRESS:

TEL NO:
08.
PERMANENT ADDRESS:

TEL NO:
09.
EMERGENCY CONTACT DETAILS
(Please mention name and address of person to be contacted in case of emergency)

TEL NO:
10.
YOUR PRESENT RESIDENCE
a)
Staying in your own house/flat
b)
Staying in company quarters
c)
Staying with parents/relatives
d)
Staying on rental accommodation
11.
RELIGION:
12.
FAMILY DETAILS
RELATIONSHIP
NAME
DATE OF BIRTH
TO BE INSURED
1)
FATHER

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Choose an item.

NA

4)

NA
5)
SISTERS

NA
6)

NA
13.
MARITAL STATUS:

Choose an item.

If married details of children with their names & date of birth

NAME
GENDER
BIRTH
DATE
DEPENDENT
(Y/N)
INSURANCE
(Y/N)
SPOUSE

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19.
CONVEYANCE
Do you own a vehicle? (If yes, please provide a copy of Registration Certificate)
Choose an item.

If No, how do you commute to office?

BB.
EDUCATIONAL QUALIFICATIONS: (Starting from Post Graduation/Graduation)
01.
Sr. No
Qualification
From
(dd.mm.yy)
To
(dd.mm.yy)
School / College
Board / University
Class / Percentage
Main Subjects
1)

2)

3)

4)

5)

Note: Copies of relevant mark sheets/certificates to be attached.

TRAINING & PRACTICAL EXPERIENCE (Other than regular jobs)
02.
Sr. No.
Nature of Training
Organization / Institution
Period

From
To
1)

2)

3)

4)

5)

6)

7)

8)

CC.
From Date
(dd.mm.yy)

DETAILS OF WORK EXPERIENCE:

Please record your experience details in chronological order starting from present employment.
To
Date
(dd.mm.yy)

Name & Address of

the Employer

Designation

Duties

Salary Net
Per Annum
(Rs.)

Reasons for
Leaving

ORGANIZATION CHART
IDENTIFY AND DRAW THE REPORTING STRUCTURE IN YOUR EARLIER ORGANIZATIONS DEPT. VIZ;
SUBORDINATES, COLLEAGUES, IMMEDIATE BOSS AND HOD.

TEXT

SELF

TEXT

TEXT

IF YOU ARE THE HEAD OF A DEPARTMENT IN THE COMPANY YOU ARE WITH, PLEASE STATE IN
BRIEF YOUR RESPONSIBILITIES, NUMBER OF PEOPLE SUPERVISED AND WHOM DO YOU RESORT TO.
ALSO STATE IN BRIEF THE NATURE OF YOUR WORK?
01.

PLEASE DESCRIBE IN DETAIL YOUR FUNCTIONS/ RESPONSIBILITIES DURING THE LAST FIVE (5)
YEARS OF YOUR SERVICE (USE SEPARATE SHEETS IF REQUIRED)
02.

WHAT KIND OF A JOB PROFILE ARE YOU LOOKING FOR?

03.

04.

DO YOU HAVE ANY CHOICE OF LOCATION OF WORK?

(Please state in order of preference)

DD. GENERAL DEVELOPMENTAL WORK:

WHAT ARE YOUR HOBBIES?
1.

IN WHICH FIELD ARE YOU BEST INFORMED?

2.

MEMBERSHIPS: Professional Societies / Social and Cultural Associations / Political, Semi Political Parties,
Educational or any other Societies and Group.

3.

EE
.

PERSONALITY (INTERESTS AND AMBITIONS)

(Please state briefly in the space provided below)

1.

WHAT SEEMS TO BE YOUR GREATER PROBLEM/ANXIETY AT PRESENT?

2.

3.

4.

5.

WHAT IS YOUR OBJECTIVE IN LIFE?

WHAT ARE YOUR GREATEST PERSONAL ASSETS (QUALITIES, SKILLS, ABILITIES), WHICH MAKE YOU
SUCCESFUL IN THE JOBS YOU TAKE UP?

WHAT DO YOU ENJOY THE MOST IN YOUR WORK?

WHAT DO YOU CONSIDER YOUR MAIN WEAKNESS?

LANGUAGES KNOWN
READ
LANGUAGE Average Good Fluent
Select as applicable.

6.

WRITE
Average Good Fluent
Select as applicable

SPEAK
Average Good Fluent
Select as applicable

7.

ANY OTHER INFORMATION YOU WOULD LIKE TO ADD.

F
F.

REMUNERATION STRUCTURE
(You may need to support this with a salary certificate)

1.
1.1

Level & Grade

Basic Salary

Present

1.2

Dearness Allowance

1.3
1.4

Fixed D.A.
TOTAL CONSOLIDATED SALARY

2.1

House Rent Allowance

2.2
2.3

Any specific facility regarding housing

TOTAL (2.1 + 2.2)

3.1
3.2

Car / Conveyance Allowance

Transport facility (specify)

3.3

TOTAL (2.3+3.1+3.2)

4.1
4.2
4.3

Bonus / Ex- gratia

LTA
Scholarship / Education Allowance

4.4

Canteen / Lunch Expenses

4.5

Entertainment Expenses

4.6

Furnishing (Hard/ Soft)

4.7
4.8
4.9

Servants
Residence/ Telephone / Maintenance
TOTAL

5.1

Provident Fund (Rate)

5.2

Gratuity (Rate)

5.3

Superannuation Fund (Rate)

5.4

Hospitalization Insurance

5.5

Medical Reimbursements (Maximum Limits)

5.6

Group Life / Accident Insurance

6.1

Gross Salary

6.2
6.3

Income Tax Paid

NET SALARY

7.1
7.2

Leave Casual / Sick / Privilege

Leave Any other (specify - )

10

7.3
8.1

Leave Accumulation / Encashment

Any Loan Facilities (Specify)

PF & PENSION RELATED

a)

Do you have a Provident Fund Account? If yes, do you wish to transfer the fund balance?

b)

Are you a member of the Family Pension Scheme (FPS)?

DECLARATION :
I Certify that the foregoing information is correct and complete to the best of my knowledge and nothing has been
concealed/ distorted. If at any time, I am found to have concealed / distorted any material / information; my
appointment shall be liable to summary termination without notice or compensation.

Place: ____________________
Date : ____________________
Signature : ________________

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DECLARATION
PRIOR ASSOCIATION
Have you ever applied or been interviewed for a job in this Company or in any of the RELIANCE Group or Associate
Companies.

Choose an item.

If Yes, please give details :

Position :

Outcome :

Have you ever worked in this Company or in any of the RELIANCE GROUP or Associate Companies before?
Choose an item.

If Yes, please give details:

ACQUAINTANCES / RELATIVES
Indicate acquaintances and relatives (in the wildest sense) associated with the Reliance group and Associate
Companies.
Name

Relationship

Particulars
(i.e. Position etc.)

REFERENCES

Name & Address of 2 persons other than relatives to whom we may write to :

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Company

SERVICE / SECRECY AGREEMENT & DECLARATION

I hereby declare that I have signed / not signed any service / secrecy agreement with my present employer. Salient
features of the service / secrecy if signed, are as follows :

Date :

Signature :

I hereby declare that the foregoing statements are true to the best of my knowledge and I understand that it will form
the basis of contract of employment if / I am employment if / I am employed by the company. If at a future date, it is
found that any of the information herein is false or incorrect in any material respect, the company will have the right
to terminate my service without any notice or salary in lieu thereof.

Date :

13

Signature :

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