Saint-Gobain Sekurit India Ltd.

A-1 SIPCOT Industrial Park, Sriperumbudur 602 105, Kanchipuram District, Tamil Nadu Please affix your latest colour photograph (passport size)

Position applied for

Function applied for

Name in Full (BLOCK LETTERS)

Surname

First Name

Middle Name

Permanent Address (BLOCK LETTERS)

Present Address (BLOCK LETTERS)

Application Form

Tel No Mobile No

Tel No Email ID

A. PERSONAL DATA Date of Birth Birth Place Nationality Passport No Gender Marital Status 1 Two Identification Marks 2 Height cms Weight kgs Age State of Domicile Do you have a passport? Date of Expiry Blood Group PAN Number Years

Previous major illness/physical handicap, if any Eyesight, if corrected. Power used In case of emergency, the person to be notified Name Address Telephone No Mobile No Relationship Right Left

B. Family Background Relationship Father/Guardian Mother Spouse Name Occupation Place of Residence

Children

Brothers

Sisters Other Dependents (if any)

C. LANGUAGE FAMILIARITY (Please mark (#) wherever applicable) Languages Mother tongue Others Speak Fluent Moderate Nil Fluent Read
Moderate

Write Nil Fluent Moderate Nil

D. ACADEMIC BACKGROUND (Please include sequential details on School, College, University & Post Graduate Education) School/College/Institute FT/ PT/ C# Year From To Degree/Diploma Awarded Main Subjects Academic Division & Distinctions Percentage (if any)

Kindly indicate: (a) for any gap between academic courses and (b) if you have taken more time than the course duration. # FT Full-time, PT Part-time and C Correspondence.

E. COMPUTER LITERACY (Please mark (#) wherever applicable) Applications MS Office-Word MS Office-Excel MS Office-PowerPoint ERP Internet Others (If any) Proficient Familiar Not Familiar

F. WORK EXPERIENCE Kindly indicate in unbroken chronological order, details of your previous employment, starting with your first employment. Kindly do not include details of your current/last employment here. Kindly explain break in services / gaps, if any. Name, Address and Phone No of Organisation Nature of Responsibility Gross Salary per annum* (in rupees) On Joining

Duration(Month & Year) From To

Last position held Designation

Reasons for Leaving

Name and designation of immediate superior

Last Drawn

From

To

Designation

On Joining

Name and designation of immediate superior

Last Drawn

From

To

Designation

On Joining

Name and designation of immediate superior

Last Drawn

From

To

Designation

On Joining

Name and designation of immediate superior

Last Drawn

From

To

Designation

On Joining

Name and designation of immediate superior

Last Drawn

*Kindly express in terms of Gross Annual Cost to the employer (for components to be included, see page 5)

G. DETAILS OF CURRENT / LAST EMPLOYMENT Name & Address of Organisation Nature of Business Companys Annual Turnover (in rupees) Name & Designation of your immediate superior Date of Joining Current Designation Key Job Responsibility Date of Leaving (In case not employed at present) Number of Employees

Draw the organisation chart of the Company/Dept indicating 2 levels above and below your position. (Kindly also indicate the total number of employees reporting to you, if any).

Reasons for Leaving/ seeking a change

Total Work Experience (including your present employment)

Years

Months

H. DETAILS OF CURRENT EMOLUMENTS: (In rupees) Elements of Compensation: Basic Salary Dearness Allowance or Equivalent House Rent Allowance Special Allowance Conveyance Allowance Leave Travel Allowance Medical Reimbursement Educational Allowance Other Allowances/Reimbursement Long Term Benefits PF (12 % of Basic salary) Gratuity (5 % of Basic salary) Superannuation l. GROSS ANNUAL COMPENSATION (Fixed) a) Performance Linked Incentives: b) Bonus: c) Other Variable Compensations (Add in the space below) 15,000 6,250 18,750 266,585 50,000 9,600 18,000 15,000 2,400 56,580 Annually Monthly Example (per annum) 125,004

ll. TOTAL VARIABLE PAY (a+b+c) FIXED + VARIABLE PAY (l+ll) d) Loans (Monetary Value)

50,000 (Avg. earned in last 3 yrs) 316,585 Scheme Outline If the company provides a loan of Rs 1 Lakh @ 5% per annum & the current rate at which banks offer loan is at 8% per annum, the value of the accrued benefit to the employee will be Rs. 3000 (3% of Rs 1 Lakh)

e) Perquisites: Accommodation Vehicle Hard furnishing/Corporate Schemes Other schemes/ Reimbursement f) Subsidised Facility: Canteen Transport lll. TOTAL VALUE OF PERQUISITES (d+e+f) TOTAL COST TO COMPANY (l+ll+ lll) * Kindly put (#) to indicate the amounts that you get on a monthly basis. 3,000 319,585 Indicate Schemes Cost value of rent

I. OTHER CAREER INFORMATION List down at least 5 significant achievements in your career

What are your short-term and long-term career plans?

Post qualification training (relevant to the position applied) Programme Title Institution Name Programme Details Month/Year

Other achievements (papers presented/ published, awards or honours received, if any)

J. OTHER PERSONAL DETAILS What are your Strengths and Areas of Improvement? Strengths Areas of Improvement

 What are the values and beliefs that have guided your life so far and how do you see them influencing your future?

What are the extra-curricular activities you enjoy the most?

Have you applied for any Saint-Gobain Group Company (India) previously? If yes, When? Department/Position Where? Outcome

Are you related to anybody employed in any Saint-Gobain Group Company? If yes, kindly give the following details: Name Relationship Department Company

Details of Membership of Associations (Kindly include membership of professional, social, cultural organisations) Name of Organisation From To Office Held

K. GENERAL INFORMATION If selected, I can take the new appointment within days.

. Are you willing to undergo extensive, long-term training abroad? If not, please state the constraining factors.

. Are you willing to execute a service agreement with the company if it provides specialised training? State Yes or No. Do you have any location preferences? If yes, kindly state the constraining factors and your location preferences.

Are you under any kind of legal obligation to your current employer? State Yes or No. What notice period do you contractually require to give to your present employer? If yes, kindly state

Any other information which you think should be taken into account in considering your application.

Give 3 references with whom you have worked or from whom you have received education or who know you professionally. (Other than relatives) Name Position held & Organisation Address & Telephone Nos Years of Acquaintance

I certify that facts stated in this application are true. I understand that any misrepresentation or suppression of information in this form will render my services liable to being terminated by the company. I have no objection to your enquiry from any of my previous employers on any matters pertaining to me, if I join the company.

Place:

Date:

Applicant's signature

THANK YOU FOR TAKING THE TIME TO COMPLETE THIS APPLICATION

Note 1. Use Enter / Tab keys to move between blocks in the application form. 2. Use ALT & ENTER keys simultaneously to move the cursor to the next line within a block in the application form. 3. Kindly attach your photograph separately along with the application form.