EAF_ 4.6 -ER

Accenture Services Private Ltd.

Access List Template

Details of Templates

S.no ClassificationName of the Document

User or Group Name Retention Media

1 Confidential EAF IDC Recruitment

One year

Soft Copy

Version Control TemplateForm No: Version Control W.e.f Sept 01, 2004

Version No Date Prepared by Reviewed byVer 1.1 05 March 2004 Smita Kumar Unmesh PawarVer 1.2 02 May 2004 Amit Relan Unmesh PawarVer 1.3 July 1, 2004 Amit Relan Unmesh PawarVer 1.4 August 5, 2004 Amit Relan Unmesh PawarVer 1.5 September 3, 2004 Amit Relan Unmesh PawarVer 1.6 Oct 16,2004 Amit Relan Unmesh PawarVer 2.0 30 March 2005 Shikha Mukherjee Unmesh PawarVer 2.1 09 May 2005 Shikha Mukherjee Unmesh PawarVer 2.2 05 September 2005 Shikha Mukherjee Unmesh PawarVer 3.0 01 November 2005 Sundara Srinivas Unmesh PawarVer 3.1 07 August 2006 Sundara Srinivas Unmesh Pawar

Ver 3.2 1 September 2008 Debasmita SahooGreeshma

GauthamanVer 3.3 15 May 2009 Debasmita Sahoo George AbrahamVer 4.0 11 Nov 2009 Aishwarya Sundar George AbrahamVer 4.1 1st July, 2012 Shweta Paralikar Anil ChadaVer 4.6 1st July, 2013 Shweta Paralikar Neerja Nath

Employment Application Form (v.4.6)

Effective from July , 2013 EAF Version 4.6

Prepared By:Shweta Paralikar

Reviewed By:Neerja Nath

Approved By:Sukhpreet Kalra

Name:EAF Date:

1st July, 13

Document No:AHRFM0009

Version No:Ver 4.6

Status:Approved

For internal use only: To be filled by AccentureEmployee ID Number: Date of Joining : Workforce :

Classification: CONFIDENTIAL

Do not forward or copy data in part or full with out explicit permission of Entity Recruitment Lead

Use Strong authentication

Retention period is Default (default as per Policy 123)


Please provide complete and correct information All fields are mandatory Please do not use short forms / abbreviations.

Personal Details

Please expand initials in your name -- As the same would be used in our Employment records

Title (Mr./Mrs./Ms.) First Name Middle Name Last Name

JASPAL KUMAR CHOUDHARYPrimary Skill / Competency SAP ABAP/4

Source/Channel ACCENTURE PORTAL

If your Source to Accenture is through a Referral, please confirm your referral is through Employee Candidate Any other Source

Employee/Candidate Name : …………NA……………… Your relation with referral: …………………NA………

Gender: Male Female Nationality: ………INDIAN………….. Citizenship: ………INDIAN…………….

If you are not an Indian National, do you have a valid work permit/OCI/PIO to work in India? Yes No If yes, work permit/PIO/OCI Card valid up-to ………NA…………….(DD/MM/YY)

If no, pl provide reason ……………………NA………………………………………………………………………………

Date of Birth : …27TH NOVEMBER, 1981……………………… Place of Birth: …ROPAR ( PUNJAB) ………………………….

Father’s Name: …SH. SURJIT KUMAR…………………………………………..

Mother’s Name: …SMT KRISHNA DEVI………………………………............... Mother’s Maiden Name: SMT. KRISHNA DEVI …………………………………..

Contact Number/s: 1 …07838092704……………………………… 2 .…0124-4081239…………………………. 3 ………………NA……………..

Personal Email ID: …[email protected]……………………………………………………….

Alternate Email ID: …[email protected]………………………………………………………..

Current Address: HOUSE NO. 7, STREET NO. 1, SHIV VIHAR, RAJIV NAGAR, GURGAON – 122001.

Phone Number: 07838092704 , 0124-4081239

Permanent Address: HOUSE NO. 1157/58, SECTOR 56, CHANDIGARH - 160055

Phone Number: 09872653235



Period of Stay

Current Address Permanent AddressFrom

(month/year)To

(month/year)From

(month/year)To

(month/year)04/2005 TILL DATE 06/2004 TILL DATE

Preferred Work Location: Bangalore Hyderabad Mumbai Chennai Kolkata Pune

NCR (Delhi/ Gurgaon/ Noida) Any of the above mentioned Locations

If you do not have a Passport, it is recommended that you apply for the same before joining. Passport Number : NA Passport Expiry Date : NA

Has your visa ever been rejected Yes No (If yes, please provide the following details)

Reason : NA

Date of rejection : NA For which country : NA

Permanent Account Number (PAN) : BGFPK1605R

NASSCOM – NSR (National Skills Registry) – IT PIN Number : NA

Driving License Number : 413138

Driving License valid up to (mm/dd/yyyy) : 11/06/2020

Reference (From your current employer only)

Name and Designation : MR. RAJENDER KOUL, SR. MANAGER SAP

Organization : SUNBEAM AUTO PVT. LTD.

Relationship : MANAGER

Address : 38/6 K.M. STONE, DELHI-JAIPUR HIGHWAY, NARSINGPUR, GURGAON - 122001 Telephone and Email ID : 0124-4129200 EXT. 272, [email protected]

Details of prior Employment with Accenture

Have you worked with Accenture before? Yes No

If yes, please mention the period (DD/MM/YYYY): From ____NA______ To_______NA___



Entity that you worked for BPO Technology Consulting Enterprise: Old Employee ID: _______NA_____



Education Details (Please mention all education details starting from highest full time degree obtained)Qualification with

Specialization (Starting from most recent)

Institution Name & City (School/College)

University Name & City / Board Affiliated To

Period(From – To)

(dd/mm/yyyy)Student ID /

Reg No.Program

(Part Time / Full Time)

% Marks/ CGPA

PG MCA SIKKIM MANIPAL UNIVERSITY

01/08/2005 – 30/06/2009

520569329 PART TIME 61.5

Graduation

BSc.it SIKKIM MANIPAL UNIVERSITY

01/06/2004 – 30/06/2004

133131068 PART TIME 59.7

HSC/ 12th

SANJAY PUBLIC SCHOOL, SECTOR 44-B,

CHANDIGARH

C.B.S.E. 01/04/2000 – 31/04/2001

2243700 FULL TIME 53.4

SSC/ 10th

GOVT. SR. SEC. SCHOOL, SECTOR 45-A, CHANDIGARH

C.B.S.E 01/04/1998 -31/04/1999

2152599 FULL TIME 47.2

Others

G-TECH ( Diploma in Advanced Programming )

TATA INFOTECH, CHANDIGARH

01/06/2001 - 30/06/2004

CGNK-0501-GTAF01-N5-

GF3543

FULL TIME 70

State reasons for gap in education (if any) : As I was employed in DSC Ltd., there is a gap of one year in my graduation and post graduation.



Ensure that you are descriptive wherever necessary – e.g. If your previous company is closed down, please do mention it. Telephone Number with specific location code, Employee Code/ ID/ Number is mandatory. If your previous employer did not provide the Employee ID, please mention and state reasons for the same.Employment details should be of the company you are on payrolls of, not of a company you are deputed to on an assignment with. In case you are showing employments experience in a skill enabling or professional Training institute the same should only be shown if you were on the payrolls of such an institute.

Employment Details (Please mention all the employments starting from the latest employment)

Note: Verification of your current employment would be obtained on or after joining Accenture.

Sl No Company Name

Address (Main office & branch where worked) with

Company Telephone – Board

Line

Employment Type &

Designation/ Position held

Reported to (Name &

Position & direct contact

number)

Employment Period

From - To(dd/mm/ yyyy)

Emp Code / Personnel No. / Social Security

No.(Mandatory if worked in USA)

Provident Fund A/C Number (refer Salary slip)

Last drawn monthly

gross salary (INR)

Reasons for leaving

Mode of separation from the organization(Pls select the below

option)

Empl

oyer

1 SUNBEAM AUTO PVT. LTD.38/6 K.M. STONE, DELHI-JAIPUR HIGHWAY, NARSINGPUR, GURGAON - 122001

Permanent Contract

MR. RAJENDER KOUL, SR. MANAGER SAP,

0124-4129200, EXT - 272

01/12/20011 – TILL DATE

20583 HR / 3670 / 8112

40767.00 CURRENTLY WORKING

Resignation Termination Absconded Closed

Operations Others(Pls

Specify)

Designation

…………………..

Empl

oyer

2 TULIP TELECOM LTD.C-160, OKHLA INDUSTRIAL AREA, PHASE I, NEW DELHI - 110020

Permanent Contract

MR. GURCHARAN SING,SR. MANAGER SAP,09818211339

01/02/2011 – 30/11/2011

12825 NA 32038.00 GOT BETTER OPPUTUNITY IN SUNBEAM AUTO PVT. LTD.



Specify)

Designation

…………………..

Empl

oyer

3 DSC LTD,K.M. 24 MILESTONE, DUNDAHERA, NH-8, GURGAON, GURGAON – DELHI BORDER

Permanent Contract

MR. HITENDER SINGH KANWAN, SR. MANAGER IT, 07799442842

01/04/2006 - 31/01/2011

20021 DL/33892/02

18890.00 GOT BETTER OPPUTUNITY IN TULIP TELECOM LTD.



Specify)Designation

…………………..


Accenture Services Private Ltd.Em

ploy

er 4 Permanent

Contract Resignation Termination Absconded Closed


Specify)

Designation

…………………..



Letter of Authorization

To whom it may concern

I agree to provide copies of mark sheets and relevant certificates. I understand that employment with Accenture is governed by Accenture Employment Policies as applicable, including satisfactory information from a background check.

I hereby certify all of the statements made on the Accenture Services Private Ltd Employee Application Form are true and complete and I understand that omission or misrepresentation of any fact may result in refusal of employment or immediate dismissal.

I hereby authorize Accenture Services Private Ltd and its representative to verify information provided in my resume and application of employment, and to conduct enquiries as may be necessary, at the company's discretion. I authorize Accenture Services Private Ltd. and its representative to initiate the necessary enquiries/checks with immediate effect; barring my current employment. Verification of my current employment can be initiated on or after the date of joining. I authorize all persons who may have information relevant to this enquiry to disclose it to Accenture Services Private Ltd. or its representative. I release all persons from liability on account of such disclosure.

Signature :

Name in Capitals :

Date :

(Please print this page, Sign, mention Name & Date, scan and upload/ share it with the recruitment POC)


EAF_ 4.6 -ER

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