HUMAN RESOURCES DEVELOPMENT DEPARTMENT

C.O. CHENNAI

Application cum Bio-data for the post of JUNIOR OFFICER

01. Name & Address of theApplicant:

Affix your recent passport size photo

02.

NationalityReligionCasteFCBCSCSTOthers

03. Native

Place With TalukDistrictState

04.Date of Birth & Age:05.Marital Status: Married / Unmarried / Widower / Widow / Divorcee06.Mother tongue:

07. a) Academic / Professional Qualification:

MajorClassMonth & YearName of TheRegular /

Degree

University /Evening /

Subject/ Divof Passing

InstituteCorrespondence

b). Technical Qualification:

Typewriting

Short Hand

S.

LanguageGrade

Month & Year

S.

LanguageGrade

Month & Year

No

of Passing

No

of Passing

01

01

02

02

03

03

c). Computer Qualification:

Degree

Month & Year of

Name of UniversityRegular / Evening /

Passing

Distance

Diploma /

Month &

Name of UniversityRegular / Evening /

Year of

Duration

Certificate Course

/ Institution

Distance

Passing

08. Employment Data:

Name of The OrganizationPosition Held

Period

Responsibilities

Place of

Work

PresentEmployer:

Designation:

Scale

:

Salary

:

Place of work:

09. Languages Known:

S.NoLanguagesReadWriteSpeak

10. Financial Status of The Family-Immovable Assets:

ApproximateAncestral /Encumbrance,Income,

NatureLocation

Acquired by Father

Value `.

if anyif any `.

/ Self Acquired

Land/site

Building

House/Flat

11. Other Assets (Value in `.):

Cash on HandCash at BankJewelsInvestmentsOthers, if any

specify

Is there any other source of : income to the applicant? (Please specify)

Is the applicant engaged in any : business or has interest in any firm? If so, mention the nature of business and the name of the firm

14.Family Background: (As per the specimen enclosed)

15. a) Have youundergoneany :

prolongedtreatment forany

of the following disorders

Kind of DisorderYesNo

Cardiac

Kidney

Pulmonary

Others, if any

Have you undergone any : surgery

If so, give details of surgery,date and Hospital:

c)Blood Group:

Are you prepared to appear for a : detailed medical examination by our Medical panel?

Do you have any objection over : the Banks right to enquire about your antecedents?

Loans, if any outstanding in your : present organization

Do you want us to take over the : loans availed from your present employer?

Whether any Disciplinary :

Proceedings have been initiated against you / are pending against you / are being contemplated against you?

Whether any case has been : registered against you / being initiated against you / is contemplated against you by any agencies like Police, CBI, etc.?

Whether any investigation civil / : criminal of nature is pending against you / is being contemplated against You?

23.Any cases filed by you in a court or : dispute raised by you against Employer / Bank

Whether any relative is working in : our Bank?

a) Time required for joining from : the date of receipt of appointment order

b) Present Salary:BP : `Allowance: `

Perks : `Total CTC: `

Are you willing to consider any : other position, if offered?

Whether willing to serve anywhere : in India?

Are you willing to consider : positions as part time or contract basis

29. Two references for verification:(Name and Address with Phone

Number)

Have you gone abroad? If so, give : details.

31. a) Are you a member or office bearer : of any service club, specify

b) Hobbies / Other Interests:

32. a) Address for Communication:

b) Mobile / Phone No.:

c) E-Mail ID:

33. Emergency Contact

a) Person Name:

b) Relationship:

c) Mobile / Phone No.:

DECLARATION

I, ___________________________, S/o-D/o-W/o _____________________

hereby certify that the information given above are true to the best of my knowledge. I further declare that if any of the information given by me found to be false / misrepresented, my appointment is liable to be terminated / cancelled without notice.

Place:

Date:SIGNATUREANNEXURE

FAMILY BACKGROUND

Occupation /

If retired

MaritalEducational

Name of theAnnualmonthly

S.NoRelationshipName (Sarvashree)Age

Nature of

StatusQualification

Ex-employerIncomepension

Employment

drawn

1Father

2Mother

3Brother(s) /

Sister(s)

4Spouse

(If Married)

5Son(s) /

Daugher(s)

Place :

Date :

SIGNATURE OF THE APPLICANT