Job Declaration Form

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Adventz Infinity @5, BN Block, Sec.-V, Salt Lake City, Kolkata-700091 Passport Size
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Job Application cum Declaration and sign through
1. Name: _______________________________________ Nick Name: _______________________________________________
2. Father’s Name: _________________________________________________________________________________________
3. Present Address (with land mark and pin code): ___________________________________________________________
______________________________________________________________________________________________________
4. Permanent Address (with land mark and pin code): ___________________________________________________________
______________________________________________________________________________________________________
5. Date of Birth: ____________________________________ Age as on Date: ________________________________________
6. Nationality: ___________________________________________________________________________________________
7. Voter Card Number: ______________________________ Aadhaar Card Number: __________________________________
8. PAN Card Number: _______________________________ Driving License Number: _________________________________
9. Marital Status: ______________________
10. Contact Number:____________________________________________
11. Contact Number (Residence): ______________________
12. E-mail Address: ________________________________________________________________________________________
13. Education Qualification:
Type of Year of Passing Grade/ Division Percentage Name of Institution/

Examination Obtained University
14. Work Experience (If any):
Sl. Name of the organization From (Date) To Functional Internal HR Posted at

No (Starting with the Present (Date) Role Grade / Band
Employer)
15. Have you been referred by any Bandhan Employee? Yes No

If Yes, please share, Employee Name: _______________________ Emp No: ____________ Mobile No: ________________
16. Have you appeared in any interviews in Bandhan Earlier? Yes No
If Yes, when: _____________________
17. Have you been subjected to any Disciplinary Proceedings Yes No
By your previous Employer (s) at any time?
If yes, please give a brief description of the case (s) and whether you were punished or exonerated in separate sheet.
18. Have you ever been Proceeded against Yes No
Under any criminal, civil statutes?
If yes, please give a brief description of the case (s) and whether you were punished or exonerated in separate sheet.
19. Have you ever been worked with Bandhan Bank? Yes No
If Yes, please share, Emp Code: ________ Location: ___________ Department: ____________ Role: _____________
20. Do you have any business loan(Single/Joint) with Bandhan Bank? Yes No
If Yes, then please share the account holder/s name:____________________________ Account No:______________________
21. Do you have any business loan (Single/Joint) with Other Bank/Institution? Yes No
If Yes, then please share the account holder/s name:____________________________ Account No:______________________
22. Do you have any relative working in Bandhan? If yes, please provide the name, employee ID and relationship:
1. ________________________________________________ 2. ________________________________________
23. Please submit details of 2 referees acceptable to Bandhan:
1. Name: ____________________________________ 2. Name: _________________________________________
Designation: _______________________________ Designation: _____________________________________
Organization: ______________________________ Organization: ____________________________________
Office Address: _____________________________ Office Address: ___________________________________
__________________________________________ _______________________________________________
Contact Number: ___________________________ Contact Number: ________________________________
Declaration
“I, __________________________, hereby authorize Bandhan Bank Ltd, or any authorized agencies of the Bank, to obtain my Credit Bureau
scoring/rating, about me from any Consumer Reporting Agency and/or Bureau including Commercial Credit Agencies or Bureaus".
"I, ___________________________ must produce a medical fitness certificate of my joining. I have to get stipulated tests done, at my own
expense/empaneled Medical center of the Bank and obtain a registered medical practitioner’s certificate and submit the same to my reporting
manager. I hereby affirm to abide by the decision of the bank with regard to my joining in the current job, based on the diagnosis.
I certify that the foregoing information and all the statements and declarations made by me are correct and complete to the best of my
knowledge and belief and no attempt has been made to conceal or withhold any pertinent information. Any falsification or
misrepresentation found in the aforesaid declarations, made by me, I may be dismissed from the services of the Bank without any notice or
any compensation in lieu of notice and/or any action which the Bank may deem fir to initiate against me and I shall abide by Bank's such
decision.
I have/will have no objection to the bank making enquires at any time (immediately/in near future) regarding the statements and /or
declarations made by me, in any manner the Bank decides to do inclusive of police enquiry into my antecedents.
Name: ____________________________________ Signature: ________________________________

Date: _____________________________________ Place: ___________________________________
For Office use only
Verified By : Cluster / Division:
Name: Designation: Code No:
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1. Name: _______________________________________ Nick Name: _______________________________________________

2. Father’s Name: _________________________________________________________________________________________

3. Present Address (with land mark and pin code): ___________________________________________________________

4. Permanent Address (with land mark and pin code): ___________________________________________________________

5. Date of Birth: ____________________________________ Age as on Date: ________________________________________

7. Voter Card Number: ______________________________ Aadhaar Card Number: __________________________________

8. PAN Card Number: _______________________________ Driving License Number: _________________________________

9. Marital Status: ______________________

10. Contact Number:____________________________________________

11. Contact Number (Residence): ______________________

12. E-mail Address: ________________________________________________________________________________________

13. Education Qualification:

Type of Year of Passing Grade/ Division Percentage Name of Institution/

14. Work Experience (If any):

Sl. Name of the organization From (Date) To Functional Internal HR Posted at

15. Have you been referred by any Bandhan Employee? Yes No

23. Please submit details of 2 referees acceptable to Bandhan:

1. Name: ____________________________________ 2. Name: _________________________________________

Designation: _______________________________ Designation: _____________________________________

Organization: ______________________________ Organization: ____________________________________

Office Address: _____________________________ Office Address: ___________________________________

Contact Number: ___________________________ Contact Number: ________________________________

Name: ____________________________________ Signature: ________________________________

For Office use only

Verified By : Cluster / Division:

Name: Designation: Code No:

Comments from verifier :

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1. Name: _ Nick Name: _________

5. Date of Birth: Age as on Date: ____

7. Voter Card Number: Aadhaar Card Number: ____

8. PAN Card Number: _ Driving License Number: ___

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Designation: _ Designation: _______

Organization: Organization: ______

Office Address: _ Office Address: _______

Contact Number: _ Contact Number: ______

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