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,
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