Page 1EMPLOYMENT APPLICATIONTo be filld in by the applicant clearly and completelySLARSEN & TOUBRO LIMITEDPOST APPLIED FOR.-Upstream EngineeringADVT REFPlease affix your recent PhotographPERSONAL DATA( SURNAME )( FIRST NAME )( MIDDLE NAME )HOW DO YOU PREFER YOUR NAME WITH INITIALS TO BE STATED IN WRITTEN COMMUNICATION ?PRESENT HOME / MAILING ADDRESS / ADDRESS FOR COMMUNICATIONCITYTEL NO.(with STD)PIN CODEMOBILE NOEMAILPERMANENT HOME ADDRESSCITYPIN CODETEL NOAGE (Yrs)BIRTH DATE( DD/MM/YYYY )SEXMALENATIONALITYRELIGIONMARITAL STATUSFEMALEBIRTH PLACESTATE OF DOMICILENO. OF CHILDRENNATIVE STATEPERIOD OF STAY IN STATE WHERE RESIDING NOW ( YRs )MARR.FOR SCHEDULED CASTE/TRIBECASTESUBCASTUNMARRTYPE OF ACCOMMODATION( Select appropriate option from the list )Monthly Rental / ChargesPaid for AccommodationRs.LANGAGUESKNOWN( Start withMother Tounge)LanguagesSpeakReadWriteYNPFATHER'S NAMEAGEDETAILS OF OCCUPATION (IF RETIRED, STATE LAST OCCUPATION)DETAILS OF FAMILY MEMBERS(Please give full details of family members including parents, spouse, children andanyother dependents)NameAgeRelationshipOccupationIOWNRENTALSHAREDEMPLOYERSPAYING GUEST

Page 2EDUCATION DETAILSDuration of CourseEXAMINATION PASSEDSPECIALISATIONSUBJECTFULL / PART TIMEYRSMTHSSCHOOL / COLLEGEINSTITUTIONNAME OFUNIVERSITYGRADE%MARKSYEAR OFPASSINGDEGREE /DIPLOMA CERTIFICATEAWARDEDDISTINCTIONS / SCHOLARSHIPS / PRIZES WONSSC or EquivalentSchool Leaving CertificateIntermediate or 12th Standard / HSCDIPLOMAAUTOMOBILECHEMICALDiplomaCIVILB.Sc.(Tech)M.E.COMPUTER SCIENCEDEGREEB.Sc.(Engg)M.Tech.INSTRUMENTATIONB.E.M.S.ELECTRICALB.Tech.M.Sc.(Tech)ELECTRONICSB.Chem.P.G.D.B.AINDUSTRIAL ENGINEERINGB.S.M.B.A.ELEC. & INSTR.M.F.M.MECHANICALPost Grad. Degree / Diploma CertificateM.P.M.PETROLEUMM.M.S.PRODUCTIONFinanceMarketingPersonnelMEMBERSHIP OF PROFESSIONAL INSTITUTEDURATION OF MEMBERSHIPNAME OF INSTITUTETYPE OF MEMBERSHIP AND POSITION HELDPERIODFROMTO

Page 3TrainingName of the Training CourseDurationYearInstitute / OrgazinationWhether CertificateAwardedPapers Published / PresentedTITLENAME & DATE OF THE SEMINAR/JOURNAL IN WHICH PRESENTED / PUBLISHEDEXTRA CURRICULAR ACTIVITY(e.g. sports,social & Literary activities etc.)ACTIVITYINSTITUTION / ASSOCIATIONSOCIETY / CLUBYEARPOSITION HELDPRIZES WONHEALTH DATAHEIGHT (cms)WEIGHT (Kg)POWER OF GLASSESIDENTIFICATION MARKSPHYSICAL DISABILITYIF ANYMOST RECENT SERIOUSILLNESSFROMTONO. OF DAYSNATURE OF ILLNESSDo you or your spouse suffer from any of the following conditions/diseases1. Diabetes4. High Blood Pressure2. Cardiac5. Other major illness/major operation & duration3. AsthmaCRIMINAL RECORDHave you ever been involved in any criminal proceedings / convicted of any offence ?If yes, Please give detailsIII

Page 4 WORK EXPERIENCEIn unbroken chronological order starting from your first employment and ending with present employment(please account for all the periods of time not covered by education / training)EMPLOYER'S NAME & ADDRESS(Please give Full address)DURATIONLAST POSITION HELD / DESIGNATIONNATURE OF DUTIESGROSS EMOLUMENTS (Rs. PER MONTH)FromAT THE TIME OF JOININGTONAME & DESIGNATION OF IMMEDIATE SUPERVISORLAST DRAWNNo. of Yrs .FromLAST POSITION HELD / DESIGNATIONAT THE TIME OF JOININGTONAME & DESIGNATION OF IMMEDIATE SUPERVISORLAST DRAWNNo. of Yrs .FromLAST POSITION HELD / DESIGNATIONAT THE TIME OF JOININGTONAME & DESIGNATION OF IMMEDIATE SUPERVISORLAST DRAWNNo. of Yrs .FromLAST POSITION HELD / DESIGNATIONAT THE TIME OF JOININGTONAME & DESIGNATION OF IMMEDIATE SUPERVISORLAST DRAWNNo. of Yrs .FromLAST POSITION HELD / DESIGNATIONAT THE TIME OF JOININGTONAME & DESIGNATION OF IMMEDIATE SUPERVISORLAST DRAWNNo. of Yrs .FromLAST POSITION HELD / DESIGNATIONAT THE TIME OF JOININGTONAME & DESIGNATION OF IMMEDIATE SUPERVISORLAST DRAWNNo. of Yrs .FromLAST POSITION HELD / DESIGNATIONAT THE TIME OF JOININGTONAME & DESIGNATION OF IMMEDIATE SUPERVISORLAST DRAWNNo. of Yrs .

Page 5DETAILS OF CURRENT EMOLUMENTSPARTICULARSEMOLUMENTSYEARLY(Rs.)MONTHLY (Per Month)Present(Rs. p.m.)Expected(Rs. p.m.)Proposed(to be filled by L&T)MONTHLY EMOLUMENTSBASIC0DEARNESS ALLOWANCE OR EQUIVALENT0HRA0CONVEYANCE(Do you own a Car / any other vehicle)CITY COMPENSATORY ALLOWANCE0SALES COMMISSION / INCENTIVE0EDUCATION ALLOWANCE0ANY OTHER (Please Specify)0i.0ii.0iii.0SUB TOTAL (A)0.000.00ANNUAL BENEFITSBONUS ( %) ON RS.0LEAVE TRAVEL ASSISTANCE (LTA)0ANY OTHER (Please Specify)0i.0ii.0iii.0SUB TOTAL (B)00RETIREMENTBENEFITSPROVIDENT FUND ( %) CONTRIBUTIONBY EMPLOYER0SUPERANNUATION0GRATUITY0SUB TOTAL (C)00GRAND TOTAL (A+B+C)0.000.00Medical ReimbursementLimitHOSPITALIZATIONDOMICILLIARYANY OTHER (Please Specify)V

ENTER FIGURES IN THIS COLUM ONLY.DO NOT ENTER ANYTHING IN THIS COLUMN. ITS A CALCULATION.

Page 6Sr.No.ParticularsPresentProposed(to be filled in byPersonnel DeptOTHER PERQUISITESVI

Page 7Draw in the brief organisation structure of the Company where you are presently employed indicating two levels above you and one level below your position. (Please also indicate the total number of persons under you).SIGNIFICANT ACHIEVEMENTS :mention some of the major contributions made by you in your present and previous jobs :EXPLAIN WHY YOU CONSIDER YOURSELF SUITED FOR THE POSITIONVII

Page 8GENERAL DATAHave you ever been interviewed by any of the L&T Group of CompaniesYES / NOIf Yes, give detailsDate/YearPositionCompanyRELATIVES / ACQUAINTANCE IN L&T GROUP OF COMPANIESNAMERELATIONSHIPPOSITIONCOMPANYWho referred you to us ?Are you engaged in any Personal Business ?YES / NOIf yes, indicate nature of businessDO YOU HAVE ANY CONTRACT / BOND WITH YOUR PRESENT EMPLOYERIf selected, when can you join ?If Yes, Please give detailsYES / NOName & addresses of Two references. (Not Relatives)1.2.DECLARATION UNDER SECTION 314 OF COMPANIES ACT, AS AMENDED IN 1974( Strike out whichever is not applicable )I hereby declare that I am not connected with any of the Directors of the Company as hispartner or his relative as defined under Section 6 of the Companies Act, 1956.ORI hereby declare that I am a partner or relative ofMr. A Director of the Company as .I declare that the information given above is true to the best of my knowledge. I am awarethat any false or incorrect information by me may result in termination of my services withthe Company. I have no objection to your inquiring from any of my previous employers onany matters pertaining to me, if I join your CompanyPlace :Date :Applicant's Signature