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SRIRAM INSTITUTE FOR INDUSTRIAL RESEARCH

(A UNIT OF SHRIRAM SCIENTIFIC AND INDUSTRIAL RESEARCH FOUNDATION)
19, University Road, Delhi-110007
Contact No.: 011-27000100 Extn.:231
Email: hrd@shriraminstitute.org
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Name
First Last
Date of Birth
Place of Birth
Email
Phone No :
Present Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Contact No.
Permanent Address:
Same as present address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Home Town Address
Same as present address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Contact No. of Permanent Address:
Contact No. of Home Town Address

Physical

Age As On Today :	Height : Cm.	Weight : Kg.	Any Disability :

Personal
- Single
- Married
- Divorced
- Widowed
Language
Speak : Read : Write : Mother Tongue :
Particulars of places where you have resided for more than one year during the last five years.
From (Date: DD/MM/YY) To (Date: DD/MM/YY) Residential address in full
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Are you a member of Schedule case/tribe? If so, state the name there of.
Have you been involved in any court proceedings ?
Have you suffered from any contagious disease? if yes, specify.
Have you ever (directly or indirectly) been connected with any political organization? If yes, please detail particulars.
Is any of your relation in sales/ manufacturing business? If so, specify.
Have you been without employment at any time? If so, specify the period and the reasons.
Have you been interviewed by us before? If yes, for what post ?
Do you know computer basic operations? If so, specify.
List of Professional, Social, Religious and cultural organization of which you are a member.
S.No. Organization Name
EDUCATIONAL HISTORY (Starting from 10th) ACADEMIC & TECHNICAL
S.No. Name of the Exam Name & Address of the Institution Board/ University Year of Entering Year of Leaving Subjects Div. / Grade % Marks
TRAINING
S.No. Programmes /Courses attended Duration Conducted by
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SERVICE PARTICULARS EXPERIENCE & PAST EMPLOYMENT
S.No. Org. Name Address From (Date: DD/MM/YY) To (Date: DD/MM/YY) No. of Months Monthly Salary (Rs.) Basic Monthly Salary (Rs.) Total Designation / Area(s) of work

Employer's detail (Reverse chronological order)
DESCRIBE THE SCOPE OF RESPONSIBILITIES UNDER EACH PREVIOUS EMPLOYER AS NUMBERED ABOVE:-
S.No.
EXTRA CURRICULAR ACTIVITIES
S.No. Literary/Cultural Arts Sports Hobbies
S.No. Technical Societies Joined or Membership of Technical Societies Honours & Scholarship Publications & Papers Presented
-4- REFERENCES
Please give at least two references from among your Supervisors at your workplace or head of Deptt./ Professor of your college.
S.No. Name Address Occupation May be contacted? (Y/N) Email ID Contact No.
Name(s) of person(s) if any, known /related to you in our Institute.
S.No. Name Designation Division Relationship
FAMILY PARTICULARS
S.No. Relation Name D.o.B. (DD/MM/YY) Dependent on you (Yes/No) Present Address Profession Designation Official Address Approx. monthly income
GENERAL NOMINATION
I
- S/o
- D/o
- W/o
Name
appoint the following person to be my nominee to receive, in the event of my death, all the dues payable to me as per the rules of the Institute on account of unpaid emoluments / salary etc.
Nominee Name Nominee Address Relationship with nominee Nominee D.o.B. In case of minor Nominee's Guardian Name In case of minor Nominee's Guardian Address
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SHRIRAM INSTITUTE FOR INDUSTRIAL RESEARCH

( A Unit of Shriram Scientific & Industrial Research Foundation)

DECLARATION

1. I shall, if and when required, take up casual/ temporary/ permanent duty in the discharge of Institute’s assignment outside the office premises.
2. I shall be whole time employee of the Institute.
3. I shall never undertake any outside assignment/ profession during the course of my employment in the Institute without prior permission of the management.
4. I certify that the foregoing information is correct and complete to the best of my knowledge and belief and nothing has been concealed. I am not aware of any circumstances which might impair my fitness for employment in SHRIRAM INSTTITURE FOR INDUSTRIAL RESEARCH, if, at any time, I found to have concealed any material information or given any false details, against any of the above particulars, my appointment shall be liable to termination without notice.
Place :
Date
Signature :
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DECLARATION OF CONFIDENTIALITY & IMPARTIALITY
I
- S/o
- D/o
- W/o
Name
Working As
working as at Shriram Institute For Industrial Research, 19 University Road, Delhi-110007 ("Institute"), do hereby state and undertake the declaration of Confidentiality and Impartiality and inform that:-
1. I shall observe professional secrecy with regard to all the information gained by me while working in the Institute and shall not part with any information to any person other than those who are entitled to see or receive the same as per the Code of Conduct / policy of the Institute.
2. I shall ensure that the confidential information and proprietary rights of the customers of the Institute shall be protected at all times.
3. I shall not involve in any activities that would diminish confidence in the competence, impartiality, judgement or operational integrity of the Institute.
4. The activities carried out by me for the Institute shall be without any bias and I shall impart my duties in complete impartial manner.
5. Impartiality shall not be compromised by me due to any undue commercial, financial or any other pressures e.g. from relations or shared resources.
6. I shall not do anything that is detrimental to the interest of the Institute.
Place :
Date
Signature :
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Maximum File Size Should Be 10 MB.
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SHRIRAM INSTITUTE FOR INDUSTRIAL RESEARCH

( A Unit of Shriram Scientific & Industrial Research Foundation)

E-JOINING REPORT

Officer In-Charge,
HR & Administration,
Shriram Institute for Industrial Research,
19, University Road,
Delhi - 110007

Dear Sir/ Madam,
With reference to your appointment letter No.
Dated
I hereby report myself for duty with effect from
- FN
- AN
Please do the needful.
Thanking you,
Yours faithfully,
Name :
Place :
Date
Signature :
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