Employment application form

PwC SDC

Full name
(in block letter) (First name) (Middle name) (Surname)

Please mention your name as on Pan Card/ Passport.

Please read all instructions carefully and complete all sheets accurately.
Please mention dates in "DD/MM/YYYY" format only (for eg : 31/08/2010).

Page 1
Personal information

Name
(in block letters)

Gender

Father's name
(in block letters)

Date of Birth (DD / MM / YYYY)

Blood group Affix your

most recent photograph

Marital status

Date of marriage (DD / MM / YYYY)

Nationality

Birth location Birth country

(City/ State)
Languages spoken (mother tongue first):

Language 1 Language 2 Language 3 Language 4

Language

Speak

Read

Write

Current address

Address line 1 (house no.

/apartment name)
Address line 2 (street
name/area name/plot no.
/sector)

Address line 3 (location

name/landmark)

City State

Contact no.
Pincode
(home)

Contact no.
Email id
(mobile)

Emergency contact Relationship with

person employee

Emergency contact no.

Permanent Address

Address line 1 (House no.

/apartment name)
Address line 2 (Street
name/area name/ plot no.
/sector)

Address Line 3 (Location

name/landmark)

City State

Pincode

Name Signature

Page 2
Academic background

Upto Graduation
Dates (DD/MM/YYYY)
Examination passed School/ Institute Board Percentage of marks/CGPA
From To Part Time/Full Time

SSC / 10

HSC / 10+2

Graduation
Dates (DD/MM/YYYY)
Examination passed Institute/College University Percentage of marks/CGPA
From To Part Time/Full Time

Post Graduation only

Dates (DD/MM/YYYY)
Examination passed Institute/College University Percentage of marks/CGPA
From To Part Time/Full Time

Professional Qualification
Current
Dates (DD/MM/YYYY) Percentage of
Name of course Institute status
From To Part Time/Full Time

marks/CGPA
(Valid/Inv

If CA please tick as applicable

CA Qualifies CA Qualifies CA Qualifies CA Qualifies

Inter Qualified Year
1st attempt 2nd attempt 3rd attempt 4th attempt

Break in studies (If any) From dd/mm/yyyy To dd/mm/yyyy

Reason

Break between completion of study and employement (If any)

Years Months

Reason

Name Signature

Page 3
Employment history (In chronological order beginning with the current organisation. Information provided should be supported by relieving/ release letter at the time of joining)

Tenure in the organisation

Organisation name Designation *Annual cost to company
(DD/MM/YY)
(First Party/Third Party/Deputation/Etc.) -
as per documents Reporting to Department and role
From To
On joining At the end On joining At the end
(DD/MM/YYYY) (DD/MM/YYYY)

Benefits from last employer (Tick your response)

1. Office car (describe entitlement) : Yes No

Break During Employment (If any) From dd/mm/yyyy To dd/mm/yyyy

Reason

Name Signature

Page 4
Other information

Job Related capabilities:

Yes No
Would you be willing to relocate?

Have you applied to/worked with us

Yes No
before?
If yes, please share details.

What is your desired salary?

What is your preferred joining date?

How did you come to know about this *PwC Contract Career Advertisement Others
vacancy? Employee Agency Portal
(Please check the appropriate source) Name and
Employee ID

References

(Please provide details of professional references (supervisors or seniors you have worked with)

Reference details Reference 1 Reference 2

Name

Address

Contact number

Position/Title

Organisation

Period of acquaintance (years)

Nature of acquaintance

Can PwC SDC contact this referee prior to

an offer acceptance being made? (Yes/
No)

Note to interviewer: Joining date 2 Monday in month

Do you have relative(s) working in PwC SDC or PwC network? Yes No

If Yes, please specify the following

Location & Employee Relationship with the

Full Name
ID employee

Please note, PwC SDC personal relationship at work policy requires full disclosure for all relationship prior and during employment with PwC SDC. Relationship include but not limited to
spouse, parents, siblings, cousins, uncles, aunties, niece, nephew, in-laws, personal intimate relationships etc.

Name Signature

Page 5
Identification details

PAN number
*Mandatory document to be submitted within 2 months of joining
Do you have appropriate
entitlement to work in India Yes No
(e.g. Visa, India passport)

Do you have a passport Yes No Country of citizenship

Passport no.

Date of issue

Date of expiry

Place of issue

Visa details-to work

in other countries

VISA date of issue

VISA date of expiry

Please provide full details in case you select "Yes" as an answer to the following questions Yes No
(Tick yes or no in the respective box)

Have you ever been arrested by police for any reason?

Did any one make /lodge any FIR against you:

Are you in relation to any individual directly or indirectly working with the state or central govt. of India ?

If Yes, list down the name & profession of the individual and in what capacity the individual is related to you

Declaration

I certify that the information furnished above is factually correct and subject to verification by PwC (including Reference Check & Background
Verification) I accept that an appointment given to me on this basis can be revoked and/or terminated without any notice at any time in future if any
information provided by me has been falsified, misleading or deliberately omitted/suppressed. I also certify that I am at present in a sound mental and
physical condition to undertake employment with PwC SDC.

I agree Yes No

Date (DD/MM/YYYY)

Place Signature

Page 6