EMPLOYMENT APPLICATION FORM

OUR PEOPLE VISION :

We will build one of the World's most performance driven, process efficient and people friendly learning organization to attract the best and the brightest who will be delivering optimum value, design and experience to our customers on a sustainable basis. We will create a work environment which will be responsive, respectful and delightful.

OUR PEOPLE MISSION :

" Build the best employer brand to attract, nurture, engage and inspire the best talent as required for our business. " Recruit, train and retain 5,00,000 people over next four-five years. " Create effective internal HR organization (people+processes+technology) and develop vendors to meet the goals mentioned above.

"We at Reliance strongly believe in creating Equal Employment opportunity for all by employing people who reflect the diverse nature of society and value people and their contribution irrespective of age, gender, disability, sexual orientation, race, color, religion or ethnic origin."

This form is intended to help us record important information about you. Please complete the form in full and use additional sheets if necessary. We trust that the information provided is correct. We wish you all the best to have a successful career with Reliance.

"Grahak Devo Bhava : Service to customer is Service to God" Application Blank is for internal use of Reliance Retail Ltd. only.

E.C. No. :_________________________

( To be filled by HR dept. )

PERSONAL INFORMATION:
Name : Hare Kumar Registration No: Grade : Location : Sub Function : 07.02.1989 Indian Place of Birth (City & State) : Muzaffarpur.Bihar Gender (Male / Female) : Blood Group : Single Hindu cut on right chick Marriage Annv. Date : Not Applicable 51861732 Position Applied / Designation : Date of Joining : Function / Department : Date of Birth : Nationality : Height (in cms) : Marital Status : Religion : Identification Mark :

Please indicate the category to which you belong Physically Handicapped

Scheduled Caste Scheduled Tribe Other Backward Class Ex - Sevicemen General No No No No No Yes

Indicate the Type of Employment

Full Time Part Time Consultant Temporary Position Contract Retainership No No No No No No

Mention the Sub Caste : Nature of disability (for Physically Handicapped candidates) :

CONTACT INFORMATION
1. Present Address : Lovely Professional University, Jalandhar-Delhi G.T. Road Jalandhar Jalandhar Punjab 144806 India 2. Permanent Address : V.P.O: - Keotsa, P.S:-Gaighat, District: - Muzaffarpur Muzaffarpur Muzaffarpur Bihar 847107 India

Residence Tel. No. : Mobile No. E-Mail Id :

NO 7696201564 kumar.harekrishna99@gmail.com

Residence Tel. No. : Mobile No. : E-Mail Id :

NO 7696201564 kumar.harekrishna99@gmail.com

Attachments
Attachment Type Resume Attachment Name Resume.doc

"Grahak Devo Bhava : Service to customer is Service to God" Application Blank is for internal use of Reliance Retail Ltd. only.

EDUCATIONAL QUALIFICATION : (Please mention Last/ Recent qualification first and give details upto SSC) Degree
MBA

Duration From
02.06.2010

To

Name of School/College
MBA(Markeing)

Board / University
Lovely Professional University

Location
Jalandhar,,India

Main Subjects
Marketing Marketing

Marks Obtained
5.93 CGPA

01.06.2012

Note : Copies of relevant marksheets to be attached.

FAMILY BACKGROUND : Name

Sunil Kumar Singh Meera Devi Dev krishna Tulsi kumari

Relationship
Father Mother Brother Sister

Date of Birth
04.07.1965 08.02.1970 11.02.2004 04.07.2000

Education
Intermediate/HSC High School/SSC Other Qualification Doctorate

Occupation
Agriculturist/Farmer House Wife Student Student

LANGUAGES KNOWN: (Underline your mother tongue) S.No. Language

HINDI(Mother Tongue) 1 2 3 4 Yes

Read
Yes

Speak
Yes

Write

Please mention your Hobbies/ Interest : Listening to music and Making friends

"Grahak Devo Bhava : Service to customer is Service to God" Application Blank is for internal use of Reliance Retail Ltd. only.

DETAILS OF WORK EXPERIENCE:

TOTAL EXPERIENCE:

0.00

YEARS

Please put your experience in chronological order starting from last/present employment.

S.No From

Duration To

Name & Address of Employer

Designation

Duties/ Job Reason for Industry Fixed Variab Leaving Type Responsibilit Pay le Pay ies

0 0 0 0 0 0 When can you join if you are selected (Applicable in case Offer letter not issued) MORE THAN THREE MONTHS Last/ Present Job Responsibility:

Name of Last Employer Address Industry Type No. of Employees supervised & their job type Major Duties & Responsibilities
Nil ,

Kindly draw your present organization chart indicating your position clearly:

"Grahak Devo Bhava : Service to customer is Service to God" Application Blank is for internal use of Reliance Retail Ltd. only.

OTHER DETAILS:
1. Bank (Name & Branch) : 2. Bank A/C No. 3. PAN No. : : BBPPK5442M

Note: Reliance Retail has a tie-up with HDFC and ICICI Bank only. Hence if you already have an A/C with
any of these banks then you can give the A/C No. or else you are requested to open a new a/c in either of the banks for your payroll.

PRIOR ASSOCIATION:
1. Have you ever worked with RELIANCE Group or any of its Associate Companies before? If Yes, Please give details: Name of the Company: Entry Date: 2. Position: Exit Date:

No

Have you ever being interviewed before by us for any other position? If yes, Please give details.

No

3.

Are you a member of Professional Societies/ Social & Cultural Association, Political Parties, Educational or any other Societies and Group? If Yes, Please give details.

4.

How did you learn about this position? No No No No Other Source (Please Employee Reference Career Fair No No

RIL Site Job Site Advertisement Word of Mouth

ACQUAINTANCES/RELATIVES WORKING IN THE COMPANY: Name S.No

1. 2.

Relationship

Particulars (i.e. Position held etc)

Company

REFERENCE CHECK -Give at least 2 references (Not Relations) whom we can refer for verification : Name & Designation
1. 2.

Organization

Address

Tel/Mobile

E-mail ID

1. Have you been criminally prosecuted?

No

If Yes, then please mention the details below:

2. Has any disciplinary action been initiated against you in any of your previous employment? If yes Please give details below:

No

"Grahak Devo Bhava : Service to customer is Service to God" Application Blank is for internal use of Reliance Retail Ltd. only.

PRESENT/ LAST SALARY DRAWN Particulars Monthly Components

Basic Salary HRA Conveyance Allowance Special Allowance City Compensatory Allowance Education Allowance Any other monthly allowance: 1. 2.

Monthly (Rs.

Annual (Rs.

(A) Total Monthly Salary Annual Components

LTA Medical Performance Linked Incentive/Pay Bonus/ Ex- Gratia Loan Facility (Please specify) Any Other Annual Component 1. 2. Any other Perq./Allowance/Benefits

(B) Total Annual Components Retirals

Provident Fund Superannuation Gratuity

(C) Total Rrtials Present Gross Salary/CTC (A+B+C) Any other detail that you would like to specifyExpected CTC Notice Period for Joining

SERVICE/SECRECY AGREEMENT & DECLARATION:

Are you having any service/ secrecy agreement or bond with your present employer? Salient features of the service/ secrecy agreement if signed, are as follows:

No

Date:

Signature:

Can we refer to your present employer?

No

I hereby declare that the forgoing statements are true to best of my knowledge and latest. Nothing has been distorted/ concealed and I understand that it will form the basis of contract of employment if / I am employed by the company. If in future date, it is found that any of the information herein is false or incorrect in any material respect, the company will have the right to terminate my service without any notice or salary in lieu thereof. Date: Signature:

"Grahak Devo Bhava : Service to customer is Service to God" Application Blank is for internal use of Reliance Retail Ltd. only.