Revised Employment Application Form Ver2.6[1]

Accenture Services Private Ltd

Doc Ver 2.6

Employment Application Form For internal use only: To be filled by Accenture

Employee ID Number: Date of Joining : Workforce :

Please attach recent passport size photograph

 Please provide complete and correct information.  All fields are mandatory.  Please do not use short forms / abbreviations.  Hardcopy of this form along with supporting documents has to be submitted (duly signed & with a recent colour photograph) to your location contact point.

Personal Details Please expand initials in your name -- As the same would be used in our Employment records Title (Mr./Ms.)

Mr.

Accenture Middle Name Services Private Last NameLtd

First Name

Education Details

Roopkumar

Qualification with Institution Name & SQL City Server University Name & City Primary Skill / .Net 2.0, Specialization / Board Affiliated To Competency(School/College) (Starting from most recent)

MCA

Period (From – To) (dd/mm/yyyy)

Doc Ver 2.6

Balasundaram Student ID / Reg No.

Program (Part Time / Full Time)

% age marks / CGPA

MC12138

Full

78

2712428

Full

64

01/04/199601/03/1997

769460

Full

57

01/04/199501/03/1996

102567

Full

72

Gender: St.Joseph’s o Male ocollege Femaleof Nationality: …Indian….. Indian University of Madras Citizenship: 01/04/2001 – Engineering 01/04/2004 Date of Birth : …02/04/1980……… Place of Birth: Chennai

Maiden Name: (applicable for married ladies): ………………………………………. Bsc Computer Pachaiyappa’s College University of Madras 01/04/1997 – Science Father’s Name: P.G. BalaSundaram 01/04/2000 Mother’s Name: B.Hamsa HSC/ 12th Mother’s Doveton Corrie………………………………….. Boys State Board Maiden Name: Higher Secondary Contact Number/s: 9840355433/044-26424708 SSC/ 10th

Others

Personal Email ID: [email protected] Doveton Corrie Boys State Board Higher Secondary Alternate Email ID: [email protected] Current Address :

Permanent Address :

Old No.30, New No. 77, Tana Street, Purasawalkam, Chennai - 600007

Old No.30, New No.77, Tana Street, Purasawalkam, Chennai - 600007

State reasons for gap in education (if any) : Phone Number : 044-26424708

Period Of Stay

Phone Number : 044-26424708

Current Address From To (month/year) (month/year)

Current

Permanent Address From To (month/year) (month/year)

Current

If you do not have a Passport, it is recommended that you apply for the same before joining. Passport Number : G1238617

Accenture Services Private Ltd

Doc Ver 2.6

Employment Details (Please mention all the employments starting from the latest employment) Note: Verification of your current employment would be obtained on or after joining Accenture. Company Name

iSOFT Global Services India Pvt. Ltd.

Address (Main office & branch where worked) with Company Telephone – Board Line Hafiz Court, 19, Dr.M.G.R.Salai, Nungambakkam, Chennai - 34

Employment Type & Designation/ Position held

□ Permanent □ Contract Designation

Reported to (Name Employme & Position & direct nt Period contact number) From - To (dd/mm/ yyyy) Anand, Project Manager, 9789091767

17/07/200426/12/2006

Govarthanan, I.T.Analyst

26/02/2007 – Till date

Emp Code / Personnel No. / Social Security No. (Mandatory if worked in USA) 1457

Last drawn monthly gross salary (INR)

206368

34000/-

Software Engineer

□ Permanent □ Contract Designation

Asst. Systems Engineer

Employer 3

Siruseri Special Economic Zone, Plot No. 1/G1, SIPCOT IT Park, Siruseri, Navalur Post, Kancheepuram Dist., Tamilnadu 603013

□ Permanent □ Contract

Employer 4

Tata Consultancy Services Pvt. Ltd.

□ Permanent □ Contract

Employer 5

Employer 2

Employer 1

Sl No

□ Permanent □ Contract

Designation

…………………..

Designation

…………………..

Designation

…………………..

•

Reasons for leaving

Mode of separation from the organization (Pls select the below option)

□ □ □ □ □

Resignation Termination Absconded Closed the operations Others(Pls specify)

□ □ □ □ □

Resignation Termination Absconded Closed the operations Others(Pls specify)

□ □ □ □ □

Resignation Termination Absconded Closed the operations Others(Pls specify)

□ □ □ □ □

Resignation Termination Absconded Closed the operations Others(Pls specify)

□ □ □ □ □

Resignation Termination Absconded Closed the operations Others(Pls specify)

Ensure that you are descriptive wherever necessary – e.g. If your previous company is closed down, please do mention it. Telephone Number with specific location code, Employee Code/ ID/ Number is mandatory. If your previous employer did not provide the Employee ID, please mention and state reasons for the same

Accenture Services Private Ltd •

Doc Ver 2.6

Employment details should be of the company you are on payrolls of, not of a company you are deputed to on an assignment with. In case you are showing employments experience in a skill enabling or professional Training institute the same should only be shown if you were on the payrolls of such an institute.

Accenture Services Private Ltd

Doc Ver 2.6

Letter of Authorization To whom it may concern If employed by Accenture, I agree to provide copies of mark sheets and relevant certificates. I understand that employment with Accenture is governed by Accenture Employment Policies as applicable, including satisfactory information from a background check . I hereby certify all of the statements made on the Accenture Services Private Ltd Employee Application Form are true and complete and I understand that omission or misrepresentation of any fact may result in refusal of employment or immediate dismissal. I hereby authorize Accenture Services Private Ltd and its representative to verify information provided in my resume and application of employment, and to conduct enquiries as may be necessary, at the company's discretion. I authorize all persons who may have information relevant to this enquiry to disclose it to Accenture Services Private Ltd. or its representative. I release all persons from liability on account of such disclosure.

Signature

:

Name in Capitals : Date

:

For internal use only: To be filled by Accenture

*Signature of the Recruiter

:

Name of the Recruiter

:

Date

:

* The Signature of the recruiter needs to be present in case the application is sent as soft copy and does not have the signature of the candidate. The hardcopy of the email received also needs to be submitted along with this form as an audit trail.