Application No. (for office use)

PETRONET CCK LIMITED

APPLICATION FORMAT

1 Post applied for

2 Name of the candidate (in Block Letters)

3 Sex (Please tick () mark in the appropriate box)

Male Female

4 Marital Status (Please tick () mark in the appropriate box)

Unmarried Married

5 Date of Birth * (DD/MM/YYYY)

6 Father’s Name

7 Mailing Address 8 Permanent Address

Pin Code Pin Code

9 Contact Telephone Number (with STD Code for land line)

10 e-mail ID

(* Attach attested photocopies of certificates)

Affix recent

Passport size

photograph here

11 Educational Qualifications (Attach attested photocopies of Degree Certificates and mark sheets of all semesters)

Examination

passed Subject / Specialisation

Name of Institute /

University

Year of

Passing

% of

marks

Class/

Division

12 Previous Experience (in chronological order)

Organisation (Name, Location and nature of business)**

Posts held

Duration (exact dates to

be given) Nature of Duties**

From To

**Attach additional sheets if required

I, hereby declare that all the statements made in this application are true and complete to the best of

my knowledge. If at any stage of the selection process, the above statements are found to be false or

incomplete, I understand that my candidature will stand cancelled.

Place: _____________________ Signature __________________

Date: _____________________ Name __________________