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Gujarat Green Revolution Co Ltd.

PO: Fertilizernagar-391 750, District: Vadodara (Gujarat)


Phone: (0265)2243069 Fax: (0265)2241685 website: www.ggrc.co.in Affix
Please note that incomplete form will not be considered
Pass-Port
Size
Post applied for _______________________________________________________ Photograph
FULL NAME: Mr / Mrs / Miss

(In Block Letters) ___________________ ____________________ ____________________


(SURNAME) (FIRST) (MIDDLE)

Present Address:

(Contact Ph/Mob.__________________________________)
Place of Birth: Village: ______________________ District _________________________ State ___________________
Date of Birth: __________________________ Age: ____________ Years __________Month

Nationality_______________ Religion ___________ Blood Group__________


____________________________________________________________________________________________________
Occupation of Husband / Wife ___________________________
Occupation of Father / Guardian ___________________________
Languages known: Read Write Speak
(a) ________________ ________________ ________________ ( Mother Tongue)
(b) ________________ ________________ ________________
(c) ________________ ________________ ________________
(d) ________________ ________________ ________________

Do you belong to Schedule Caste / Tribe? Yes / No


Do you belong to Backward Class? Yes / No If yes, attach
Are you a Land loser? Yes / No the True Copy
Are you an Ex-serviceman? Yes / No of Certificate / s
Whether physically handicapped. Yes / No
Have you any relative working in GGRC Ltd?
If yes, give following details Yes______ No _____
Name Designation Department/Unit
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EDUCATIONAL QUALIFICATIONS (Starting with Pre-university or Equivalent):
Examination Institution Board / Year of Class / % of Marks Principal
University Passing Division Obtained Subject

Scholastic Honour / Scholarships / Prizes etc P.T.O


TRAINING UNDERGONE:
Name of Organization / Duration
Institute From To Stipend or
Brief Description of Training
Honorarium

EMPLOYMENT HISTORY (Starting with your Present Job):


Duration
Sr Name and Address of Salary drawn
Position/s held From To Nature of Work
No Company / Organization

How soon can you join duty, if selected? Minimum total emoluments acceptable

Hove you ever been dismissed / discharged / terminated for any act of misconduct in any of your previous employment or
convicted for any criminal or other offence? Yes / No ________
If yes, give compact and precise details on a separate paper

REFERENCES – (Not related to the applicant and must be residing in India)


No Name Address Occupation

1.

2.
Extra curricular activities (Proficiency in Sports / Games (if any), Hobbies, etc

Any other relevant information in support of your application, e.g. Membership of professional organization, research
papers, articles and any other publication and merit awards, etc (use separate sheet, if required)
Declaration
A. Should any information stated by me in this application be found incorrect, my employment with Company is
liable for immediate termination without payment of any compensation thereof.
B. I declare that I had no previous conviction.

Date: __________________ Signature: ____________________

Place: __________________ Name: ____________________

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