EMPLOYMENT APPLICATION FORM
(Trainee Scheme)
Please fill up personal data from completely as we value this in our selection process
Name in Full (in Capital & underline Surname)
Please fill up the personal data form completely as we value this in our selection process.
Sex Marital Status Date of Birth Age (Yrs) Place of Birth
M/F
Language Speak Read Write
Nationality
Height (cm) Affix latest color photograph
Language known
(indicate (Passport size)
Weight (kg) whether Fluent,
Fair or poor and
Power of underline mother
Lens (if tongue)
relevant)
Blood Group
Physical Disability / major
illness
Present Address (In Block Letters) Permanent Address (In Block Letters)
Phone Number Phone Number
(Specify area code) (Specify area code)
Mobile Number E-Mail
Person to be contacted in case of Emergency (Name) Phone Number Relationship
Family Details (parents / brothers / sisters / spouse / children)
Resident of
Name Relationship Age Qualification Occupation (Company & designation)
(Location)
Are you willing to work any where in India? YES/ NO
Details
Please of Relatives
Indicate preferred working inreason
location with this company:
for the choice
Education Record (Starting with std. X & XII, Diploma /Degree year wise
Board/ Period Main % of
Examination/Degree Institution Subject/ marks
University
From To Specialization Grade
/div
Gaps in Education (if any):
Computer Literacy
Applications Expert Familiar Don’t Know
Word/Excel/Power point
CAD/CAM/Pro-E
ERP
MS DOS, WINDOWS 98, WINDOWS 2000 & WINDOWS XP
Others
Memberships
Professional Institutions Nature of Association
Social / Cultural / Political Organizations Nature of Association
Projects undertaken / Vocational Training
Period
Title of project Institute /Organization
From To
Achievements
What do you regard as the most significant achievement so far?
Extra Curricular Achievements
Activity Level Prices/Award Captainship/Position
Campus Life
Have you been a boarder at school or college? YES OR NO
If ‘yes’ indicate your major learning from your life in campus
Values and Beliefs
What are the beliefs and values that have guided your life so far and how do you see them
influencing your future?
Profile
Reflect on one significant person if any who has influenced your life so far. In which
way?
Also whether any author/book has influenced you?
Curricular Interest
Work Life Personal Life
Strengths and limitations
Strengths Limitation
Development
How will you ensure your continuous learning and development?
Medical Information
Do you have any medical problems or any illness issues or any kind of phobia? If Yes (Mention in
words)
Do you have any of following? If Yes (Tick on it)
BP/ Hypertension / Diabetes / Allergies / Asthma / Heart Problem
Chest Pain/ Thyroid
Education Plans
A. Do you have plan for higher education? YES OR NO
If ‘yes’ please give details and indicate what time frame you have in mind for the
same? (If you do not disclose these now and leave for higher studies during the
training the period you may be required to refund the stipend amount paid to you)
B. Have you already applied or intend to apply to any institute for higher studies?
YES OR NO
If ‘yes’ give details.
Note: Saying yes to any of the above does not rule out your selection into our training scheme.
Career Plans
What is your career plan?
Other Information
Any other information you would like to give.
Declaration
I certify that the foregoing information is correct and complete to the best of my knowledge and
belief. I am not aware of any circumstances, which might impair my fitness for employment. I
also do hereby authorize Piaggio to do Background Verification on me. If at any time, I am
found to have concealed any material information or given any false details, my appointment
shall be liable to summary termination without notice or compensation.
Place
Date
Signature of applicant
Human Resource
