Application Form 1k655y

CANDIDATE APPLICATION BLANK

Reference Code / Sr. #

(to be filled prior to first interview)

SKILLS:

Total Experience (Yrs.Mths):

Technical Expertise In:

Experience (Yrs.Mths):

Domain/Functional Expertise In:

Photo

Experience (Yrs.Mths):

I. Personal Details

* Name: Mr/Mrs/Ms

Mitra

(as in your port)

Last

Religion:

Hindu

Kaustav

Kumar

First

Middle

Mother Tongue:

Bengali

*

Date of Birth:

22/06/1988

Present Address: 62, Old Police Line Road, Gorabazar City:

Berhampore

Business Tel No:

State: West Bengal Mobile:

Pincode:

9051487076

742101

Personal Email Id:

Home Tel No: [email protected]

Permanent Address: 62, Old Police Line Road, Gorabazar City:

Berhampore

Emergency details

State: West Bengal Name:

Pincode:

742101

Kalyan Kumar Mitra

Tel No: Relationship:

### Father

Current Address: 62, Old Police Line Road, Gorabazar City:

Berhampore

PAN #:

BBUPM7200E

State: West Bengal

Pincode:

742101

Home Tel No:

Existing HDFC Saving #:

Driving License #:

Expiry Date:

port #:

Place of Issue:

Branch Name:

Expiry Date:

Citizenship:

Have you ever applied for a Work Permit/Visa: Y/N N

l

When:

Country:

Have you ever been rejected a Work Permit/Visa: Y/NN

If Y,

When: When:

Country: Country:

Languages Known

Written

Spoken

English

Yes Yes

Bengali

Yes Yes

###

Languages Known

Written

Hindi

Yes

Spoken Yes

II. Family Background Name Kalyan Kumar Mitra

Date of Birth Occupation

Name Child 1(male/female)

Date of Birth

Occup

Service Late Madhuri Mitra

Child 2 (male/female) NA

Spouse(marriage date)

Child 3 (male/female)

III. Education (Matriculation Onwards In Reverse Chronological Order) Qualification B-TECH

Year of ing From To

West Bengal University Of Technology 2006

Higher Secondary ICSE

University/Board

Percentage(GPA)

2010

7.67

Scholastic Achievment, If Any

WBCHSE

2004

2006

90.4

CISCE

2003

2004

90.17

Year

Certification/Training[Soft/Technical]

IV. Professional Certification/Training Certification/Training[Soft/Technical]

Year

CANDIDATE APPLICATION BLANK (to be filled prior to first interview)

Reference Code / Sr. #

CANDIDATE APPLICATION BLANK

Reference Code / Sr. #

(to be filled prior to first interview)

V. Previous Employment History (Reverse Chronological Order) Organization

Duration

Designation From

To

Responsibity (nature of resp, team size, managerial role, etc.)

Compensation (Cost to Company)

VI. Currrent Organisation Structure (Indicate Your Position)

VII. Professional Achievements(Awards/Recognition)

VIII. Extra Curricular Activities

IX. Have You Been Interviewed By Capgemini Earlier? Y/N If Y, When (mm/yy):

Interviewer's Name:

X. Do you have Relatives/Friends in Capgemini? Y/N If Y, Name:

N

Kingshuk Bardhan

What was the outcome? Y

Relationship:

Friend

Yrs.Mths Known:

20 years

XI. References Professional

Professional

Personal

Personal

Name Relationship Years Known Company Name Title or Occupation Home Tel No Business Tel No

XII. Current Salary Break-Up Monthly

Annual

Basic

Medical

HRA

LTA

Conveyence

PF

Others (Pls Specify)

Gratuity

1

Bonus

2

Others (Pls Specify)

Readiness to work on Night Shift

3 Monthly Gross

1

Yes

working days Expected CTC

Lacs

No

(Please circle)

2 3 Annual Gross

Declaration

Notice period

Readiness to work on Projs.

Yes

No

(Please circle)

CANDIDATE APPLICATION BLANK (to be filled prior to first interview)

Reference Code / Sr. #

I, hereby declare that the above information provided by me is true and accurate to the best of my knowledge. I was never arrested by police or have a criminal record. Any falsification of this information will hold me liable to the action taken against me by the organisation as per it's prevailing rules and regulations.

Kolkata

29/09/2010

SIGNATURE: Kaustav Kumar Mitra