EMPLOYMENT APPLICATION FORM

POST APPLIED FOR:

FULL NAME IN BLOCK LETTERS

JAISWAL VISHESH

(LAST) (FIRST) (MIDDLE) PLEASE AFFIX

YOUR RECENT
PASSPORT SIZE
PRESENT HOME MAILING ADDRESS: FLAT NO 103 NISH 1 APPARTMENT SANJAY NAGAR AMRANE NAGAR PHOTOGRAPH

NEAR AIRFORCE TRAINING CENTRE 560094

PIN CODE 560094

TELEPHONE (With Code) CELL:

E-MAIL : visheshjais99@gmail.com BIRTH DATE [DD/MM/YYYY]

PERMANENT HOME MAILING ADDRESS: WARD NO 22 BOURIPARA AMBIKAPUR SURGUJA 8/16/1994

NEAR DEEPAK KIRANA STORE AGE (YRS) 29

PIN CODE 497001 BIRTH PLACE

TELEPHONE (With Code) CELL: AMBIKAPUR

MARRIAGE DATE
GENDER MARITAL STATUS NATIVE STATE RELIGION NATIONALITY STATE OF DOMICILE
(If Married)

MALE SINGLE KARNATAKA HINDU INDIAN CHHATTISGARH

PERSONAL DATA

CASTE SC ST DT NT SBC OBC GEN.CAT [Other than GEN.CAT please arrange to produce Caste Certificate]

LANGUAGES KNOWN (Including Foreign) SPEAK READ WRITE PASSPORT NO.

HINDI PASSPORT ISSUE DATE

ENGLISH VALID UPTO DATE

COUNTRY OF ISSUE

VALID VISA DETAILS

PAN NUMBER

DETAILS OF FAMILY MEMBERS (parents, spouse, children, siblings & any other dependents excluding self)

NAME RELATIONSHIP DATE OF BIRTH QUALIFICATION OCCUPATION ORGANIZATION AND POSITION

OMPRAKASH JAISWAL Father 15-Jan-66

RITA JAISWAL Mother 12-Jun-71

ANKIT JAISWAL BROTHER 4-Oct-98

EMERGENCY CONTACT DETAILS NAME OM PRAKASH JAISWAL

ADDRESS WARD NO 22 BOURI PARA AMBIKAPUR SURGUJA CHHATTISGARH

RELATION FATHER TELEPHONE NO. 9826171914

HEALTH DATA

HEIGHT (cms) WEIGHT (kg) BLOOD GROUP EYESIGHT [SPECIFY POWER IF WEARING GLASSES/LENSES] PHYSICAL DISABILITY (IF ANY)
N/A
169 72 O + ve Right 6 BY 6 Left 6-Jun

1
 HEALTH DAT
N/A

MOLE MARK IN HEAD

IDENTIFICATION MARKS

EDUCATION
WHETHER DURATION OF DISTINCTIONS /
SPECIALISATIO SCHOOL / COLLEGE / UNIVERSITY/ FULLTIME / MONTH & YEAR GRADE %
EXAMINATION PASSED PARTTIME/
COURSE SCHOLARSHIPS / PRIZES
N INSTITUTION BOARD OF PASSING MARKS
CORRES. (Yrs & Mths) WON

SSC OR Equivalent
School leaving Certificate
SCIENCE KV AMBIKAPUR CBSE FULL TIME 1 Year 2010 62.04 FIRST

MATHS
Intermediate or VIKAS VIDYANIKETAN
PHYSICS CBSE FULL TIME 1 Year 2012 76.02 DISTINCTION
12th standard / HSC VIZAG
CHEMISTRY
DIPLOMA
DEGREE (S)

MECHANICAL
B TECH CSVTU BHILAI CSVTU FULL TIME 4 Years 2016 8.14 DISTINCTION
ENGINEERING
POST. GRAD. DEGREE /
DIP. CERTIFICATE

MEMBERSHIP OF PROFESSIONAL INSTITUTE

DURATION OF MEMBERSHIP
NAME OF INSTITUTE TYPE OF MEMBERSHIP AND POSITION HELD
PERIOD FROM
N/A

TRAINING / CERTIFICATIONS
WHETHER CERTIFICATE
NAME OF THE TRAINING COURSE DURATION YEAR INSTITUTE / ORGANISATION
AWARDED

CCNA 6Months

PAPERS PUBLISHED / PRESENTED

TITLE NAME & DATE OF THE SEMINAR / JOURNAL IN WHICH PRESENTED / PUBLISHED

N/A

EXTRA CURRICULAR ACTIVITY (E.G. Sports, Social & Literary activities etc.)
ACTIVITY INSTITUTION/ASSOCIATION/SOCIETY/CLUB YEAR POSITION HELD PRIZES WON

SKILLS SUMMARY
(Give brief details for the projects you have worked on)
PROJECT TITLE ROLE TEAM SIZE DURATION LANGUAGE / PLATFORM / OS

2
ROBOTICS SEIMANS ROBOTICS PROJECT 9 MEMBERS 1Year C++, Coding

WORK EXPERIENCE
In unbroken chronological order starting from your present employment and ending with first employment
(Please account for all the periods of time not covered by education / training) [Please attach extra sheet if required]
EMPLOYER'S NAME DURATION
LAST POSITION HELD DESIGNATION NATURE OF DUTIES
& ADDRESS PERIOD(Yrs.)
First Level of Troubleshooting for IT Related queries
Service desk Engineer
FROM
12-Jun-21 NAME & DESIGNATION OF IMMEDIATE SUPERIOR
TO
Sandeep V Team lead
Wipro limited 9th March 2024

GROSS EMOLUMENTS Rs. AT THE TIME OF JOINING LAST DRAWN

Per month 57517
BASIC (P.M.) FIXED (P.A.) VARIABLE (P.A.) GROSS (P.A.)
Details of Current
Emoluments 50779 700000 25272
57517
ambailapur Sarjapur
DURATION
road kodathi gate LAST POSITION HELD DESIGNATION NATURE OF DUTIES
PERIOD(Yrs.)
560099
Tech support on HP Laptops and Printers
Tech support Engineer
FROM
11-Aug-20 NAME & DESIGNATION OF IMMEDIATE SUPERIOR
Concentrix daksh India
Pvt Ltd TO
Abhishek (Team lead)
31-May-21

GROSS EMOLUMENTS Rs. AT THE TIME OF JOINING 39000 LAST DRAWN

Per month 39000
EMPLOYER'S NAME DURATION
LAST POSITION HELD DESIGNATION NATURE OF DUTIES
& ADDRESS PERIOD(Yrs.)
Tech support on Routing , Switching and Networking
Network support Engineer related issues.
FROM
3-Mar-19 NAME & DESIGNATION OF IMMEDIATE SUPERIOR
Tech Mahindra Noida TO
Akansha Kaushik
25-Jun-20

GROSS EMOLUMENTS Rs. AT THE TIME OF JOINING 25000 LAST DRAWN

Per month 25000
EMPLOYER'S NAME DURATION
LAST POSITION HELD DESIGNATION NATURE OF DUTIES
& ADDRESS PERIOD(Yrs.)
Tech support on Currency sorting machine Also
Assistant Engineer worked on Automated Robotics PLC'S currency
FROM packaging Machine .
21-Aug-16 NAME & DESIGNATION OF IMMEDIATE SUPERIOR
Giesecke and devrient
India Pvt Ltd TO
Lokesh
28-Feb-19

GROSS EMOLUMENTS Rs. AT THE TIME OF JOINING 10000 LAST DRAWN

Per month 15000
EMPLOYER'S NAME DURATION
LAST POSITION HELD DESIGNATION NATURE OF DUTIES
& ADDRESS PERIOD(Yrs.)

FROM
NAME & DESIGNATION OF IMMEDIATE SUPERIOR
TO

GROSS EMOLUMENTS Rs. AT THE TIME OF JOINING LAST DRAWN

Per month

EMPLOYER'S NAME DURATION

LAST POSITION HELD DESIGNATION NATURE OF DUTIES
& ADDRESS PERIOD(Yrs.)

3
 FROM
NAME & DESIGNATION OF IMMEDIATE SUPERIOR
TO

GROSS EMOLUMENTS Rs. AT THE TIME OF JOINING LAST DRAWN

Per month

DRAW IN BRIEF THE ORGANISATION STRUCTURE OF THE COMPANY WHERE YOU ARE PRESENTLY EMPLOYED INDICATING TWO
LEVELS ABOVE AND ONE LEVEL BELOW YOUR POSITION (PLEASE ALSO INDICATE THE TOTAL NUMBER OF PERSONS UNDER YOU)
The traditional line structure is organized in such a way that a president or CEO (Chief Executive Officer) is at the top. Then there are the directors or VPs
(Vice-Presidents) of specific areas, followed by managers, and so on, until the operational personnel. This structure can be seen below:

Small business organizational structure examples - Inline, functional and staff aligned structures

It’s a very rigid structure, with little information exchange, typical of bureaucratic companies in which there is little collaboration.

Total Included 9 members in our team

am a good candidate for this position, as I have experience working in different work environments of varying team and company sizes, often in a fast paced
environment. My excellent communication skills allow me to create working relationships based on trust and mutual respect

HAVE YOU EVER BEEN INTERVIEWED BY ANY OF THE L&T GROUP OF COMPANIES?
YES NO DATE/YEAR POSITION COMPANY
If Yes, give
details

RELATIVES / ACQUAINTANCE IN L&T GROUP OF COMPANIES

NAME RELATIONSHIP POSITION COMPANY & TELEPHONE NOS.
GENERAL DATA

HOW DID YOU COME TO KNOW OF THIS POSITION?

ARE YOU ENGAGED IN ANY PERSONAL BUSINESS ? if YES,

indicate nature of
YES NO business

DO YOU HAVE ANY CONTRACT / BOND

WITH YOUR PRESENT EMPLOYER? if YES,
Give Details
YES NO

IF SELECTED, WHEN CAN YOU JOIN?

NAME, ADD., AND TEL Nos. OF TWO SUPERIORS FAMILIAR WITH YOUR WORK (NOT RELATIVES)
NAME COMPANY & POSITION TELEPHONE NOS. E-MAIL ID

HAVE YOU EVER BEEN INVOLVED IN ANY CRIMINAL PROCEEDINGS / CONVICTED OF ANY OFFENCE? IF YES, GIVE DETAILS
CRIMINAL
RECORD

DECLARATION UNDER SECTION 314 OF COMPANIES ACT, AS AMENDED IN 1974 (Tick whichever is applicable)
I hereby declare that I am not connected with any of the Directors of the Company as his partner or his relative as defined under section 6 of
the Companies Act 1956

4
 OR
I hereby declare that I am a partner or relative of a Director of the Company

as .

I declare that the information given above is true to the best of my knowledge. I am aware that any false or incorrect information by me may result in
termination of my service with the Company. I have no objection to your inquiring from any of my previous employers on any matters pertaining to me, if I join
your Company.

PLACE BANGALORE DATE 8-Mar-24 Applicant's Signature

5
ORM

EASE AFFIX
UR RECENT
SSPORT SIZE
HOTOGRAPH

ATE [DD/MM/YYYY]

8/16/1994

29

RTH PLACE

MBIKAPUR

STATE OF DOMICILE

CHHATTISGARH

duce Caste Certificate]

ATION AND POSITION

DISABILITY (IF ANY)

6
 DISTINCTIONS /
CHOLARSHIPS / PRIZES
WON

FIRST

DISTINCTION

DISTINCTION

MBERSHIP
TO

ER CERTIFICATE
AWARDED

D / PUBLISHED

PRIZES WON

E / PLATFORM / OS

7
UTIES

for IT Related queries

57517
GROSS (P.A.)

57517
UTIES

ops and Printers

39000
UTIES

tching and Networking

ues.

25000
UTIES

orting machine Also

otics PLC'S currency
chine .

15000
UTIES

UTIES

8
 directors or VPs

ften in a fast paced

COMPANY

HONE NOS.

E-MAIL ID

9
may result in
aining to me, if I join

10