Format HR / Recruitment / Employment Application Form 1.1b

1. Name:_ Ajay V._____________________________________________________ (First Name) (Middle Name) (Surname)

2. Present Address with phone number Permanent Address with phone number

3. Date of Birth: 19/04/1985 Sex: Male. Religion: HINDU

4. Marital Status: Unmarried No; of Children: 0

5. Do you have your own Vehicle: Yes

6. Any Medical Disability: NO Eye Sight: 6/6

7. EDUCATIONAL QUALIFICATION

Education Name of School/College

Institute/Division

Major Subjects

% of Marks

Division/Grade

Year of Passing/Attempt

SSC D.A.V ADAMBAKKAM

CBSE SCIENCE

70 2000 – 1

HSC T.V.S.M., COIMBATORE

TN STATE BOARD

BIO, PHYSICS, MATHS

60 2003

Graduation IGNOU IGNOU BIOLOGY

50 ________

Post. GraduationAny Other

Computer Literacy

SYS/HR/ F/Emp. Appl-1.1b/Rev02/Date of issue-18 Sep 12

Please affix your recent

photo.

13/17, Shankar Mansion, Nedunchalai Nagar, Kasakanoor (Opposite to Sona College), Salem

Mobile#: 91-8760977483MailID: ajaywriter@rediffmail.com

No. 13, Sri Ramajayam, Rajaji Nagar, Lawspet, Pondicherry

8. FAMILY DETAILS: ( Dependants)

Relationship Name Age Qualification Occupation

MOTHER UMA MAHESWARI 51 BA EDITOR – E-PUBLISHING

SISTER AISHWARYA 24 MBA STUDENT

9. .OCCUPATIONAL DETAILS (Please start with present Employment)From:JAN 2009-

To: AUGUST 2014

Name of the Company:CANNY CARE SOLUTIONS

Business: MEDICAL TRANSCRIPTION

Annual Turnover:

Designation: SR. QUALITY AN ALYST

Reporting To:

TEAM LEADER

Salary at the time of Joining: JANUARY 2009

Salary at the time of Leaving

Reason of Leaving

PERSONAL

24,000

From:MARCH 2004

To:

FEBRUARY 2008

Name of the Company: PHARAOH SOLUTIONS

Business:

Annual Turnover:

Designation:TEAM LEADER,

Reporting To:

Salary at the time of Joining: 6500

Salary at the time of Leaving 19000

Reason of Leaving

CHANGE OF PROFILE

SYS/HR/ F/Emp. Appl-1.1b/Rev02/Date of issue-18 Sep 12

From:

To:

Name of the Company:

Business:

Annual Turnover:

Designation:

Reporting To:

Salary at the time of Joining:

Salary at the time of Leaving

Reason of Leaving

10. Have you attended any training course(s) workshop, seminars? Please give detailsTraining at RND SOFTECH, COIMBATORE, LASTING FOR SIX MONTHS.

Extra Curricular Activities/Interests T.V. VIEWING

11. Do you have any relative/ Friends serving in MModal Please give details.LATHA, from Salem.

12. Please describe briefly your major achievements and your Interest in seeking employment with MModalAchievements including persistent and dedicated efforts to build up quality and work as a team and strengthen the entire teams morale in terms of distress. Being available when in need.

13. Do you have any Liability with your Present employer, If Yes, give details.No.

14. If selected, time required to join.

14 days

15. Do you have any objection if we refer to your previous Employer, If No, give details?YES. Canny care solutions Chennai.

16. Present Salary: 25000/-

SYS/HR/ F/Emp. Appl-1.1b/Rev02/Date of issue-18 Sep 12

17. (Proof submitted) _________________

18. Basic DA Other Allowance Total

19. Salary Expected: 28000/-

20. REFERENCES (Please provide full mailing address with phone No)Personal1 Gemini Ganesh 09562620330 2

Professional1 2

DECLARATIONI declare that all the information and particulars given by me in this form are true to the best of my knowledge and belief. I fully understand that if any of the Information given above is found to be incorrect or deliberately distorted, my application may be rejected or my services may be terminated at any time without notice by MModal.

Date: 20/08/2014A

Signature of Applicant

HR Comments:

SELECTED / REJECTED : _______________ Joining Date : ________________________

Department : ________________________ Gross Salary :________________@ annum.

Remarks :__________________________________________________________________

Signature: ________________________

SYS/HR/ F/Emp. Appl-1.1b/Rev02/Date of issue-18 Sep 12

Format HR / Recruitment / Manpower Requisition Form 1.1c

Annexure for Employee Application Fo rm ( Technical positions like – MLS, QA, Editors )

1. Write 100 words about yourself: I am Ajay, I have been working in the medical transcription industry for the past 10 years now and have been bread winning for the long years now. I am committed, responsible, and take work serious enough to keep ethical standards at work high. I am motivated by spirituality and the need for work life balance to lead a peaceful and self-sufficient life. My strengths include patience, perseverance, and appreciate quality of life and effort dedicated to performing duties. My weakness include taking responsibility for the common good.

2. Details about your Medical Transcription work experience:

Sr. No

Name of the Organization(Address / Phone no.)

No. of MT’sEmployed

Kind of files that exist/ existed

Capacity/ Volume of work per day in hours

Volume of work came from

Major Clients/TAT/ quality Level’s

1CANNY CARE SOLUTIONS

20 HOSPITAL AND CLINIC, MIXED

2 NUANCE

--

2 RAM TECH 40 MIXED 2 NUANCE

--

3. Details of your own Training:

Sr. No

Trained at

Specific Training (Subjects)

Duration in days (hours @ day)

Certification test

Experience in live production

Any Other information

1 Rnd Softech

AnatomyPhysiologyLanguage of medicinePractice of transcripti

SYS/HR/ F/Emp. Appl-1.1b/Rev02/Date of issue-18 Sep 12

onEnglish language and grammar

4. Personal Capabilities:

Medicine specialties: _________________________________________________________

Capability of how many lines @day: 1200 +

Your own Accuracy Level: 98.75

Your current Designation: SR. QUALITY ANALYST

Your own Level in the last organization: SENIOR QUALITY ANALYST

Interviewer’s assessment:

Of the Audio Test conducted on Dead file

Of the Grammar Test conducted on line / written

Of the Essay / 100 words written on self

Interviewer’s name and signature

RemarksOn suitability of the candidate:Selected / Short listed / Active / Rejected

SYS/HR/ F/Emp. Appl-1.1b/Rev02/Date of issue-18 Sep 12