EMBIOTIC LABORATORIES (P) LTD.,
56/1, Sreegandha Kawal, Kottigepalya, Magadi Road, Bangalore - 560 091
Tele/Fax : 91 180627, 2385211 E-mail : embiotic@vsnl.net

APPLICATION FOR EMPLOYMENT

	Position Applied for	:
	Personal Data
1.	Name	:
			(First Name)               (Middle Name)           (Last Name)
	Your Email ID	:
2.	Permanent Address	:
3.	Present Address	:
4.	Age & Date of Birth	:	Years   (DD-MM-YYYY)
5.	Marital Status	:	Married     Single
6.	If Married, spouse's Name & Qualification	:
7.	Is Spouse Employed	:	Yes    No
8.	Father's Name & Occupation	:
9.	Mother's Name & Occupation	:
10.	Hobbies & Intersts	:
11.	Languages Known	:	Can Read	Can Write	Can Speak
12.	In case of emergency whom to contact (Name & Address of close relative)	:	Tel :
13.	Are you related to any one in this company (If yes give full details)	:
14.	Is anybody referring you to this company (If yes, give full details)	:
15.	Are you willing to work anywhere in India?	:	Yes     No	Give your preferred locations
16.	If Selected when can you join?	:
17.	Do you have any health problem?	:	Yes     No	If Yes, give details
18.	Have you undergone any operations?	:	Yes     No	If Yes, give details
19.	Are you ready for a medical examination by company doctor?	:	Yes     No
20.	Specify your Blood Group	:
21.	References	:	Ref. 1 Tel :
			Ref. 2 Tel :
			Ref. 3 Tel :
22.	Education Date (Starting with 10th Standard)	:
	Degree/Diploma Name of Institution/ University Period From     To - - - - - - - - - -
23.	Professional Data (Starting with Present Employment )	:
	Employees Name & Address Period From       To Possession Held Gross Salary (Rs.) Reasions for Leaving - - - - - - - -
	I declare to the best of my knowledge that the above information made by me are correct and accurate. If proved otherwise, the company has the right to take appropriate action against me which may even lead to the termination of my services, to which I agree.