Robert Bosch Engineering and Business Solutions Limited

Application for Employment

Position applied for Location Bangalore/Coimbatore Date
(Recent Passport Size Photograph to be affixed)

General Instruction Type or print this application form ; Specify all dates using DD/MM/YYYY format ; If not hand written, sign at the bottom of each page Personal Information First Name Date of birth Middle Name Gender Last Name E-Mail ID

Place of Birth: City & State

Mother Tongue

Nationality

Religion Date of Name Change Valid till

Change of Name if Applicable

(Former Name / Maiden Name )

Passport Number Current Address Door No. House Name

Date of Issue

Place of Issue

Street Landmark City Residence phone with STD Permanent Address : Same as Above Door No. House Name Street Landmark City Residence phone with STD Domiciliary state Family Information Marital Status Spouses Name - First Number of children Fathers Name - First Mothers Name - First Middle Middle Middle

State Mobile Number

Pin

State Mobile Number Period of stay

Pin

Date of Marriage (dd/mm/yyyy) : Last No. of dependents (Other than Spouse & Children) Last Last Occupation

Occupation Occupation

Registered Office: 123, Industrial Layout, Hosur Road, Koramangala, Bangalore 560 095, India Telephone : (080) 6657 5757 Telefax : (080)- 6657 1404

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Education (Begin with the highest education qualification & end with class X; Attach legible photo copies of Mark sheets / Degree Certificate / Provisional Degree Certificate) Course / Degree Post Graduation Graduation Name of Institute / University Year of passing (Month / Year) From To % of Marks /CGPA Class / Rank

Location

Specialization

Diploma Pre-University / 12th Std School / 10th Std Others

Please provide additional information for Post Graduation Post Graduation Percentage Backlogs I SEM II SEM III SEM IV SEM V SEM VI SEM Aggregate

Please provide additional information for Graduation Graduation Percentage Backlogs I SEM II SEM III SEM IV SEM V SEM VI SEM VII SEM VIII SEM Aggregate

Please provide additional information for Diploma Diploma Percentage Backlogs I SEM II SEM III SEM IV SEM V SEM VI SEM Aggregate

Registered Office: 123, Industrial Layout, Hosur Road, Koramangala, Bangalore 560 095, India Telephone : (080) 6657 5757 Telefax : (080)- 6657 1404

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Professional Work Experience (Present / Last Employment) Company Name Building No. Landmark City Employee ID Current Designation & Department Date of joining Reason for seeking change Supervisors Name & Designation Supervisors Direct Number & Mail Id Type of employment Are you under any bond? Can the employer be contacted now? Reporting structure If yes, specify bond period or amount / period If No, then provide an alternate date to contact Last drawn salary(Annual CTC) State Pin Street Key job responsibilities

(Past Employment) 1. Name of the company Building No. Landmark City Date of joining & Leaving Duration of employment Reason for seeking change 2. Name of the company Building No. Landmark City Date of joining & Leaving Duration of employment Reason for seeking change Please use additional sheet (annexure I) if space is not sufficient. Technical & Domain skills (List skills which relate to the position applied for & rate them as per scale defined) Last drawn salary State Pin Street Key job responsibilities
Last drawn salary(Annual CTC)

Key job responsibilities Street

State

Pin

Registered Office: 123, Industrial Layout, Hosur Road, Koramangala, Bangalore 560 095, India Telephone : (080) 6657 5757 Telefax : (080)- 6657 1404

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Robert Bosch Engineering and Business Solutions Limited

1 Basic Awareness; 2 End user; 3 Require guidance; 4 Can deliver independently; 5 Ability to train / guide others Skill Description Self Evaluation

Training / Development Program / Certification (Specify date in dd/mm/yyyy format) Program Name & Location of Institution Details From(Date) To(Date)

REFERENCES Details of persons under whom you have either worked or who know you professionally for at least 6 months Name Organization & Designation Nature of Association Duration E-Mail ID Phone No. (With STD Code) Residence Office

Details of friends / relatives employed in BOSCH Name Organization & Designation Nature of Association Duration E-Mail ID Phone No. (With STD Code) Residence Office

Registered Office: 123, Industrial Layout, Hosur Road, Koramangala, Bangalore 560 095, India Telephone : (080) 6657 5757 Telefax : (080)- 6657 1404

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Robert Bosch Engineering and Business Solutions Limited

Additional Details Professional Achievement Membership of Professional Association Research Papers / Articles published Patents / License Registered

Interests Achievements in Sports, Literary activities etc. Awards received Hobbies & Special Interests

Health Height (Cm) Weight (Kg) Blood Group Physical handicaps, if any, please provide details

Have you suffered from any major illness / Surgery / accident in the last five years? Chronic illness if any (high blood pressure, diabetes, etc) Information on major surgical operations if any Information on most recent illness, if any

If yes, please provide details

Statutory Membership Are you a member of Employees Provident Fund Scheme (EPF)? Are you a member of Family Pension Scheme (EPS)? Are you a member of Employees State Insurance Scheme (ESI)?

Account Number

Contact person in case of emergency (preferably local) : Name Door Number House Name Street Landmark City Residence phone with STD Relationship

State Mobile Number

Pin

Registered Office: 123, Industrial Layout, Hosur Road, Koramangala, Bangalore 560 095, India Telephone : (080) 6657 5757 Telefax : (080)- 6657 1404

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Language Proficiency Language Can Speak Can Read Can Write

Other Details Have you ever worked with any of the BOSCH entities in the past? Have you been interviewed by Bosch before?

If Yes, provide details If yes, provide details (Division / Location / Month / Year)

Have you ever been arrested, prosecuted or convicted for any criminal offence, other than minor traffic offences Social security no. / any ID no. issued by competent Government office Do you have any commitment to another employer or organization that might affect your employment with us?

If Yes, provide details

If Yes, specify the details

If Yes, provide details

Any other information you would like us to know which may have significant bearing on our hiring decision? If Yes, provide details Certification by Candidate I certify that the statements made by me above are true, complete and correct. I agree that in case the company finds at any time, the information provided by me in this application form is not correct or untrue or incomplete, the company will have the right to withdraw, if selected, the letter of appointment before I join the services or to terminate my appointment at any time without notice or compensation after I have taken up service.

I authorize Robert Bosch Engineering and Business Solutions Limited or its agency to verify my credentials. I will cooperate and facilitate the process of verification of my credentials / antecedents.

Name of the applicant

Date

Place

Signature

Registered Office: 123, Industrial Layout, Hosur Road, Koramangala, Bangalore 560 095, India Telephone : (080) 6657 5757 Telefax : (080)- 6657 1404

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Professional Work Experience (Annexure I) 3. Name of the company Building No. Landmark City Date of joining & Leaving Duration of employment Reason for seeking change 4. Name of the company Building No. Landmark City Date of joining & Leaving Duration of employment Reason for seeking change Last drawn salary(Annual CTC) State Pin Street Key job responsibilities Last drawn salary(Annual CTC) State Pin Street Key job responsibilities

5. Name of the company Building No. Landmark City Date of joining & Leaving Duration of employment Reason for seeking change Street

Key job responsibilities

State

Pin Last drawn salary(Annual CTC)

6. Name of the company Building No. Landmark City Date of joining & Leaving Duration of employment Reason for seeking change

Key job responsibilities Street

State

Pin Last drawn salary(Annual CTC)

Name: Date: Signature

Registered Office: 123, Industrial Layout, Hosur Road, Koramangala, Bangalore 560 095, India Telephone: (080) 6657 5757 Telefax: (080) 6657 1404

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Remuneration Details : Annexure II Name: Please furnish your present remuneration details. Compensation Element 1. Cash components per month: Basic Salary Dearness Allowance House Rent Allowance Conveyance Allowance Childrens Education Allowance Special Allowance Other Perquisites Gross Salary per month 2. Retirals: PF Gratuity Superannuation Total Per month 3. Cash components per annum: Incentives Bonus LTA Other Perquisites Total CTC ((1+2) X 12 +3 ) Deductions / Recoveries, if any CTC Per Annum Expected CTC Per Annum I certify that the particulars furnished by me are correct. Date of last salary revision: Date of next salary revision: Amount (Rs.) Remarks

Date :

Signature

Note: Please attach a copy of last drawn salary slip / other endorsement in support of the above particulars.

Registered Office: 123, Industrial Layout, Hosur Road, Koramangala, Bangalore 560 095, India Telephone: (080) 6657 5757 Telefax: (080) 6657

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