HMEL - Employment Form

HPCL-Mittal Energy Limited
Employment Form
Position Applied For: ___________________________________________________________________________________________________
Present Address: Permanent Address:

H.No ………………………………………………………………………… H.No ….............................................................................................
City……………………………….. District ……………………………….. City ……………………………….. District………………………………
State ……………………………… State …………………………………
Landline No .:……………………………. Mobile No .…………………… Landline No ………………………… Mobile No ………………………
Email ID. : ……………………………………………………………………. Emergency Cont. No .…………………………………………………..
Name …………………………………. Relationship…………………..
Date of Birth Place of Blood Date of Marriage
State Gender Marital Status
Birth Group
D D M M Y Y Y Y M/F Single/Married/Divorcee D D M M Y Y Y Y
Father’s Name ………………………………………………………………… Spouse’s Name: ………………………………………………………….

Religion: ……………………………………………………………….. Religion: .………………………………………………………...
Mother’s Name:………………………………………………………………. His/Her Occupation………………………………………………………..
Religion: ………………………………………………………………. Name of Employer …………….…………………………………………..
EDUCATIONAL QUALIFICATION: (Start with highest Qualification)
S. Name of Degree Year of Passing Full Time/ % of Marks

Stream / Branch Board / University
No. / Certificate M M Y Y Part Time CGPI
EXPERIENCE: Total Years of Experience ______ (Years) ______ (Months). Start with Current Employer to last employer:
S. From To Name and Location of the Employer

Full Time/
(Please write complete name of Location Position Held
No D D M M Y Y D D M M Y Y Part Time
employer)
1
2
3
Notice Period in Present Employment: ___________ Days Earliest Possible Joining Date: _______________
1|Page
Current PF No. UAN No Passport No / Validity Date PAN No Aadhar No
Bank Account No Name of Bank IFSC Code Branch Address
1) I. Have you signed a service Agreement with your present employer? II. Have you ever been prosecuted for a criminal offence YES / NO?
YES / NO If yes, please give details: If yes, please give details:
2) I. Have you attended interview / applied to HMEL before? YES/NO. II. Do any of your relatives/known person employed with HMEL?
If yes, please furnish details: YES/NO? If yes, please give details:
______________________________________________ (Position) Name_________________________ Department _______________
On: (Date)_______________________________________________ Designation______________________Relationship ________________
List TWO PERSONAL REFERENCES (not relatives or former employers)
Name Occupation Address & Telephone Number (Mobile & Land Line) Knowing
Since
What are your career objectives and how do you plan to achieve them?
What according to you are your strengths in relation to the job applied for by you?
Any other information, which you may like to furnish-
Hobbies / Interest
2|Page
Family Details
Whether dependent on you

Name Age Occupation (Yes/No)
If yes, reasons
Father
Mother
Spouse
Son (s)
Daughter (s)
If you have been involved in any court proceeding, Give particulars
Any prolonged or serious illness if you are suffering with, if yes, provide details
Physical disability, if any, please mention
Prolonged or serious illness, if any of your family member (Dependent) suffering with, provide details
3|Page
Current Employer
Name & Address of Employer
Date of Appointment
Designation on Joining
Current Designation
Department Organization Chart & Your position therein
Detailed Scope of responsibilities (in the current position)
Reasons for seeking change
Declaration
I certify that the information provided by me is correct and complete to the best of my knowledge and belief and nothing has be en
concealed. I am not aware of any circumstances which might impair my fitness for employment. If at any time, I am found to have
concealed any information or given any false details, my appointment shall be liable for termination without any notice or
compensation
Date
Place : Signature of Applicant
4|Page
CTC Break Up
Current Current Last Year
Monthly Annual Annual Salary
Basic (Fixed)
Basic Salary
PF
Gratuity
Any Other
Variable
DA
HRA
Conveyance Allowance
Medical Reimbursement
LTA
Fuel & Maintenance
Food Coupons / Food Allowance
Bonus
Performance Linked Bonus
Other Benefits
Total
5|Page

HMEL - Employment Form

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HPCL-Mittal Energy Limited

Present Address: Permanent Address:

Father’s Name ………………………………………………………………… Spouse’s Name: ………………………………………………………….

EDUCATIONAL QUALIFICATION: (Start with highest Qualification)

S. Name of Degree Year of Passing Full Time/ % of Marks

S. From To Name and Location of the Employer

Bank Account No Name of Bank IFSC Code Branch Address

______________________________________________ (Position) Name_________________________ Department _______________

On: (Date)_______________________________________________ Designation______________________Relationship ________________

List TWO PERSONAL REFERENCES (not relatives or former employers)

Any other information, which you may like to furnish-

Whether dependent on you

If you have been involved in any court proceeding, Give particulars

Physical disability, if any, please mention

Name & Address of Employer

Department Organization Chart & Your position therein

Detailed Scope of responsibilities (in the current position)

Reasons for seeking change

Place : Signature of Applicant

Food Coupons / Food Allowance

Performance Linked Bonus

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__________________________________ (Position) Name_ Department ___

On: (Date)_____________________________ DesignationRelationship