APPLICATION FORM FOR EMPLOYMENT WITH THE

U.S. MISSION, NEW DELHI, INDIA

NAME IN FULL JOB TITLE IN ANNOUNCEMENT

(Last) (First) Custodian Foreman, FSN-1305-03,

(Middle) DLA-526235

(Personal Services Agreement)

DUBEY RAHUL

SEX ANNOUNCEMENT NO.

Male : Yes VA# 10-097

Female:

PRESENT ADDRESS AND TELEPHONE NO. DATE OF BIRTH (Month, Day, Year) June,

A-31/140 Mata Mandir Marg Lane No.5, 28, 1982

Maujpur Delhi-110053

PLACE OF BIRTH (City, Country) Delhi,

India

CITIZENSHIP: Indian

NAMES AND LOCATION OF DATES DEGREE MAJOR SUBJECTS

EDUCATIONAL INSTITUTIONS

ATTENDED

From To

Apr Mar Xth English, Maths, hindi,

Natinal Open School, Delhi '99 '00 Certificate Science, Social Study

ITI Jahangirpuri, Delhi Apr Mar ITI Diesel Mechanic

'01 '02

COMPUTER EXPERIENCE: NA

SPECIAL QUALIFICATIONS AND SKILLS: List any special skills you possess, i.e.

machines, equipment.

TYPING SKILLS LICENSES/CERTIFICATION:

WPM

LANGUAGE PROFICIENCY (Level of competence)

Level I : Rudimentary Level III : Good Working Knowledge

Level V : Interpreter

Level II : Limited Knowledge Level IV : Fluency

Language Speak Read Write Understand

Hindi Level IV Level IV Level IV

English Level III Level III Level III

EMPLOYMENT: Your previous 5 positions of employment.

May we approach your present employer?

Yes No

Dates of Employment Title of Duties

Position

From: To: Working as Service Engineer, servicing

31-12-2005 Present to the generator engines

Salary (Per

Year)

Rupees

78,000.00

Name and Address of Employer

OVN Trading Engineers Pvt. Ltd, 3/5A Asaf

Ali Road, Daryaganj, Delhi

Name, Title and phone number of Immediate

Supervisor

Mr. Sandeep Singh, Area Manager,

+919*********

Reason for Leaving

Dates of Employment Title of Duties

Position

From: To:

Salary (Per

Year)

Name and Address of Employer

Name, Title and phone number of Immediate

Supervisor

Reason for Leaving

Dates of Employment Title of Duties

Position

From: To:

Salary (Per

Year)

Name and Address of Employer

Name, Title and phone number of Immediate

Supervisor

Reason for Leaving

Dates of Employment Title of Duties

Position

From: To:

Salary (Per

Year)

Name and Address of Employer

Name, Title and phone number of Immediate

Supervisor

Reason for Leaving

Dates of Employment Title of Duties

Position

From: To:

Salary (Per

Year)

Name and Address of Employer

Name, Title and phone number of Immediate

Supervisor

Reason for Leaving

REMARKS

NA

LIST ANY RELATIVES OR FAMILY MEMBERS EMPLOYED BY THE U.S. MISSION

Name Section Relationship

CERTIFICATION

Before signing this form make sure you have answered all questions fully and

completely. A false statement on this form is cause for

disqualification/dismissal.

I do solemnly affirm that the information contained herein is correct to the best

of my knowledge and belief.

Rahul Dubey

SIGNATURE DATE

Form HR-01; 05/04

Contact this candidate