To be filld in by the

applicant clearly
and completely

EMPLOYMENT APPLICATION
LARSEN & TOUBRO LIMITED
POST APPLIED FOR

ADVT REF

( 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 COMMUNICATION

TEL NO.
(with STD)

CITY
PIN CODE

MOBILE NO

EMAIL
PERMANENT HOME ADDRESS

CITY
PIN CODE
TEL NO

AGE (Yrs)

PERSONAL DATA

Please affix your recent

Photograph

BIRTH DATE

( DD/MM/YYYY )

SEX

NATIONALITY

RELIGION

MARITAL STATUS

BIRTH PLACE

STATE OF DOMICILE

NO. OF CHILDREN

NATIVE STATE

PERIOD OF STAY IN STATE WHERE RESIDING NOW ( YRs )

FOR SCHEDULED CASTE/TRIBE

CASTE

TYPE OF ACCOMMODATION
( Select appropriate option from the list )
Languages

Speak

Read

SUBCAST
Monthly Rental / Charges
Paid for Accommodation

Rs.

Write

LANGAGUES
KNOWN
( Start with
Mother
Tounge)

FATHER'S NAME

AGE

DETAILS OF OCCUPATION (IF RETIRED, STATE LAST OCCUPATION)

DETAILS OF FAMILY MEMBERS

(Please give full details of family members including parents, spouse, children and
anyother dependents)
Name

Age

Relationship

Occupation

Duration of
Course

EDUCATION DETAILS

EXAMINATION PASSED

SPECIALISATION

SUBJECT

FULL /
PART
TIME

YRS MTHS

SCHOOL / COLLEGE
INSTITUTION

NAME OF
UNIVERSITY

DEGREE /
GRADE
DISTINCTIONS /
YEAR OF
DIPLOMA
%
SCHOLARSHIPS /
PASSING CERTIFICATE
MARKS
PRIZES WON
AWARDED

SSC or Equivalent
School Leaving Certificate

Post Grad. Degree /

Diploma Certificate

DEGREE

DIPLOMA

Intermediate or
12th Standard / HSC

MEMBERSHIP OF PROFESSIONAL INSTITUTE

NAME OF INSTITUTE

TYPE OF MEMBERSHIP AND POSITION HELD

PERIOD

DURATION OF MEMBERSHIP
FROM

TO

Name:

Post Graduate Degree:

Branch:

Date of Joining:

Full/Part Time:

Instituition:

University:

Marksheet

Marks/GPA Max. Marks/

% of Marks
Obtained
GPA

Month & Year of

Exam

No. of Papers not

cleared in first
attempt

Subjects not cleared in first attempt

1st Semester/ 1st

Trimester
2nd Semester/ 2nd
Trimester
3rd Semester/ 3rd
Trimester
4th Semester/ 4th
Trimester
5th Trimester
6th Trimester
Aggregate Marks/
CGPA / % (All
Semesters)

Engineering Degree:

Branch:

Date of Joining:

Full/Part Time:

Instituition:

University:

Marksheet

Marks/GPA Max. Marks/

% of Marks
Obtained
GPA

Month & Year of

Exam

No. of Papers not

cleared in first
attempt

Subjects not cleared in first attempt

1st Semester/ Year

2nd Semester/ Year
3rd Semester/ Year
4th Semester/ Year
5th Semester
6th Semester
7th Semester
8th Semester
Aggregate Marks/
CGPA / % (All
Semesters/ Years)
Diploma in Engg./ Others (B.Sc etc.):

Branch:

Date of Joining:

Full/Part Time:

Instituition:

University/ Board:

Marksheet
1st Semester/ Year
2nd Semester/ Year
3rd Semester/ Year
4th Semester/ Year
5th Semester
6th Semester
7th Semester
8th Semester
Aggregate Marks/
CGPA / % (All
Semesters/ Years)

Marks/GPA Max. Marks/

% of Marks
Obtained
GPA

Month & Year of

Exam

No. of Papers not

cleared in first
attempt

Subjects not cleared in first attempt

Duration

Institute / Orgazination

Year

Whether Certificate
Awarded

Training

Name of the
Training Course

NAME & DATE OF THE SEMINAR/JOURNAL IN WHICH PRESENTED /

PUBLISHED

HEALTH DATA

EXTRA CURRICULAR ACTIVITY

(e.g. sports,social & Literary
activities etc.)

Papers Published /
Presented

TITLE

ACTIVITY

INSTITUTION /
ASSOCIATION
SOCIETY / CLUB

HEIGHT (cms)

WEIGHT
(Kg)

MOST RECENT SERIOUS

ILLNESS

FROM

POWER OF GLASSES

TO

POSITION HELD

PRIZES WON

IDENTIFICATION MARKS

PHYSICAL DISABILITY
IF ANY

YEAR

NO. OF
DAYS

NATURE OF ILLNESS

Do you or your spouse suffer from any of the following conditions/diseases

1. Diabetes

4. High Blood Pressure

2. Cardiac

5. Other major illness/major operation & duration

3. Asthma
CRIMINAL RECORD

Have you ever been involved in any criminal proceedings / convicted of any offence ?
If yes, Please give details

III

WORK EXPERIENCE
In 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)

DURATION

LAST POSITION HELD /

DESIGNATION

From

NATURE OF DUTIES

GROSS EMOLUMENTS
(Rs. PER MONTH)
AT THE TIME OF JOINING

NAME & DESIGNATION OF

IMMEDIATE SUPERVISOR

LAST DRAWN

From

LAST POSITION HELD /

DESIGNATION

AT THE TIME OF JOINING

TO

NAME & DESIGNATION OF

IMMEDIATE SUPERVISOR

LAST DRAWN

From

LAST POSITION HELD /

DESIGNATION

AT THE TIME OF JOINING

TO

NAME & DESIGNATION OF

IMMEDIATE SUPERVISOR

LAST DRAWN

From

LAST POSITION HELD /

DESIGNATION

AT THE TIME OF JOINING

TO

NAME & DESIGNATION OF

IMMEDIATE SUPERVISOR

LAST DRAWN

From

LAST POSITION HELD /

DESIGNATION

AT THE TIME OF JOINING

TO

NAME & DESIGNATION OF

IMMEDIATE SUPERVISOR

LAST DRAWN

LAST POSITION HELD /

DESIGNATION

AT THE TIME OF JOINING

TO
No. of Yrs .

No. of Yrs .

No. of Yrs .

No. of Yrs .

No. of Yrs .
From

NAME & DESIGNATION OF

IMMEDIATE SUPERVISOR

LAST DRAWN

From

LAST POSITION HELD /

DESIGNATION

AT THE TIME OF JOINING

TO

NAME & DESIGNATION OF

IMMEDIATE SUPERVISOR

LAST DRAWN

TO
No. of Yrs .

No. of Yrs .

DETAILS OF CURRENT EMOLUMENTS

EMOLUMENTS
MONTHLY (Per Month)

PARTICULARS

YEARLY
(Rs.)

BASIC
DEARNESS ALLOWANCE OR EQUIVALENT

MONTHLY EMOLUMENTS

HRA
CONVEYANCE
(Do you own a Car / any other vehicle)
CITY COMPENSATORY ALLOWANCE
SALES COMMISSION / INCENTIVE
EDUCATION ALLOWANCE
ANY OTHER (Please Specify)
i.
ii.
iii.
SUB TOTAL (A)

ANNUAL BENEFITS

BONUS (

%) ON RS.

LEAVE TRAVEL ASSISTANCE (LTA)

ANY OTHER (Please Specify)
i.
ii.
iii.

RETIREMENT
BENEFITS

SUB TOTAL (B)

PROVIDENT FUND (
BY EMPLOYER

%) CONTRIBUTION

SUPERANNUATION
GRATUITY
SUB TOTAL (C)

Medical
Reimbursement
Limit

GRAND TOTAL (A+B+C)

HOSPITALIZATION

DOMICILLIARY

ANY OTHER (Please Specify)

Present
(Rs. p.m.)

Expected
(Rs. p.m.)

Proposed
(to be filled by L&T)

Particulars

Present

OTHER PERQUISITES

Sr.No.

VI

Proposed
(to be filled in by
Personnel Dept

Draw 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 POSITION

VII

YES / NO
Company

Have you ever been interviewed by any of the L&T Group of Companies

If Yes, give details

NAME

Date/Year

Position

RELATIVES / ACQUAINTANCE IN L&T GROUP OF COMPANIES

RELATIONSHIP
POSITION

GENERAL DATA

Who referred you to us ?

Are you engaged in any Personal Business ?

If yes, indicate nature of business

DO YOU HAVE ANY CONTRACT / BOND WITH YOUR

PRESENT EMPLOYER
If Yes, Please give details

1.

COMPANY

YES / NO

If selected, when can you join ?

YES / NO

Name & addresses of Two references. (Not Relatives)

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 his
partner or his relative as defined under Section 6 of the Companies Act, 1956.
OR
I hereby declare that I am a partner or relative of
Mr. A Director of the Company as .
I declare that the information given above is true to the best of my knowledge. I am aware
that any false or incorrect information by me may result in termination of my services with
the Company. I have no objection to your inquiring from any of my previous employers on
any matters pertaining to me, if I join your Company

Place :
Date :

Applicant's Signature