JOINING FORM (E3) F : HR :18

CONTINENTAL CARBON INDIA LIMITED

A-14, Industrial Area No.-1, South Side of G.T. Road, Ghaziabad- 201001 (U.P.) PERSONAL HISTORY FORM
AFFIX A RECENT PHOTOGRAPH

POSITION APPLIED :

PERSONAL DETAILS:
1. FULL NAME 2. DATE OF BIRTH 3. PRESENT MAILING ADDRESS : : :

PLACE OF BIRTH

TELEPHONE NO. 4. PERMANENT ADDRESS :

MOBILE NO.

TELEPHONE NO. 5. MARITAL STATUS 6. BLOOD GROUP SINGLE/ MARRIED : SUB CASTE * E- MAIL

7. HISTORY OF ANY KNOWN DISEASE : Disease Period

8. FAMILY BACKGROUND :
NAME a) Father b) Mother c) Spouse d) Children EDUCATION OCCUPATION D.O.B. AGE

e) Brothers

f) Sisters

9. EDUCATIONAL QUALIFICATION: (Starting from SSC)

S.NO. a) b) c) d) e) f) g) EXAM PASSED YEAR OF PASSING UNIVERSITY/ BOARD MAIN SUBJECTS CLASS OBTAINED

* You may choose not to mention this information

Date of Issue 01/01/08 Rev. 01 Date of Rev 07/07/09

Continental Carbon India Limited

10. ANY SPECIAL TRAINING/ ASSIGNMENT DONE

11. DETAILS OF WORK EXPERIENCE *

Please record your experience details in chronological order starting from present employement:

DATE FROM TO

NAME AND ADDRESS OF

NATURE OF EMPLOYER'S

DESIGNATION

DUTIES

SALARY NET. REASON FOR LEAVING

* Use additional sheets if required

12. GIVE TWO REFERENCES (NON RELATIONS) WHOM WE CAN REFER FOR VERIFICATION:
NAME POSITION HELD ADDRESS AND MOBILE NUMBER

OTHER INFORMATION
How much notice period would you require to join: Additional Remark (any special qualification, experience, achievements)

Leisure Interests *

* You may choose not to mention this information

DECLARATION
I certify that the foregoing information is correct and complete to the best of my knowledge and nothing has been concealed/ distorted. At any time, if I am found to have concealed/ distorted any matter/ information, my appointment shall be liable to termination without any notice or compensation. Place: Date: Signature

FOR OFFICE USE ONLY

Interview notes and decision taken

Date

Signature of Department Head

Sign of Chief of HRD

Managing Director

Date of Issue 01/01/08 Rev. 01 Date of Rev 07/07/09

Continental Carbon India Limited

13.

COMPENSATION DETAILS

HEAD Basic Salary Dearness Allowance Fixed D.A. (if any) House Rent Allowance Conveyance Allowance/ Petrol Expense Education Allowance Canteen/ Lunch Expenses Bonus/ Ex gratia (per annum) LTA P.A./P.M. Medical Reimbursement (maximum Limit) P.A./P.M. Uniform Allowance

PRESENT

EXPECTED

PROPOSED

Superannuation Provident Fund Group Life/ Accident Insurance Policy Coverage GROSS SALARY P.M.

14. Provident Fund No. (if any)

15. Do you have superannuation scheme?

Yes

No

If yes what is yearly contribution

Signature of Applicant Date of Issue 01/01/08 Rev. 01 Date of Rev 07/07/09 Continental Carbon India Limited