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Applicant Information: Please Attach A Recent Passport-Size Photograph Here

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Applicant Information

Please attach a
A. Professional recent
passport-size
1. Position applying for: photograph
here
2. Name:

3. Contact phone no. & email address:

4. Academic Record (start with highest degree):

Degree/ Level
(Please mention subject Passing Class/Division/
# Name of the Institution
in Honours & Masters Year Grade
level)

[Add additional row(s), if necessary]

5. Employment Record (start with current job):

Duration
# Name of Organization Designation Reason for leaving
From To

3-5 key responsibilities:

3-5 key responsibilities:

3-5 key responsibilities:

[Add additional row(s), if necessary]

6. Total length of experience:

7. No. of years experience relevant to applied job:

8. If you supervised any team before then mention briefly size of the team and your role:

9. Your present/last drawn gross monthly salary including benefits (in BDT):

10. Your expected gross monthly salary including benefits for applied position (in BDT):

11. Explain reason(s) for gap in service (if more than three months):

12. Relevant Training Record:

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# Title/Subject of Training Duration Provided by Location

[Add additional row(s), if necessary]

13. Language skill:

# Language Writing Speaking

Very Very
Average Good Excellent Average Good Excellent
Good Good

[Add additional row(s), if necessary]

14. Computer skill: MS-Word MS-Excel MS-PowerPoint MS-Access , If others,


please specify:

15. Any other relevant special skills:

16. List of publication(s)/Report(s), (If any):

17. Any special achievement/distinction:

18. If you applied before in HSI for any other position then write name of the position and time:

19. Do you have any objection in making enquiries with your present and/or previous
employer? Yes No

20. Please briefly explain in maximum 200 words about your motivation for this job:

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B. Personal

1. Full name: 6. Nationality:

2. Father’s name: 7. Religion:

3. Mother’s name: 8. Ethnic identity:

4. Date of birth: 9. Disability (if applicable):

5. Sex: 10. Marital Status:

11. In your professional career were you ever terminated on disciplinary ground? If yes, give
details:

12. Were you ever convicted of a criminal offence? If yes, give details:

13. Do you have any near relatives employed with HSI Bangladesh? If yes, write name and
relationship:

14. Do you have dual nationality or any immigration with other countries? If yes then do you
need frequent travel outside Bangladesh (please specify):

15. Contact Address:

Permanent Address Mailing Address

16. Reference (with full contact details including phone and email):

Referee 1 Referee 2

17. Authentication:

Do you certify with full confidence that the information provided are authentic and accurate?
Yes No

Signature: ....................................................................... Date: ...................................

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