Radisys Employment Application Form

Radisys Employment Application Form
Radisys India Private Limited

6F, Wing B, Electra,

Exora Business Park (PTP 2)

Outer Ring Road, Marathalli,

Bangalore 560 103

P: 91-80-4014-0000

F: 91-80-4014-0001
Passport Size Photograph*

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Radisys is an equal opportunity employer. It prohibits employment discrimination on the basis of age, ancestry, color, disability, marital status, medical condition, national origin, pregnancy and genetics, race, religion, sex, sexual orientation or veteran status and will make reasonable accommodations in accordance with the law.

Please complete the application accurately and fully even if supplemented by a resume.

Type or Write in BLOCK. All information will be verified.
Surname (as in Passport)*
Date of Birth*

MonthDayYear
Permanent Account Number (PAN#) *
Given Name*
Nationality*
Passport Number*
Father’s Name (passport)*
Mother’s Name (passport)*
Place of Issue (passport)*
Current Residence Address (for communication) - (include house / apartment number, cross, main road, city, state, pin code)*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Dates & Duration of Stay*
Permanent Address (If different from above) - (include house / apartment number, cross, main road, city, state, pin code)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Dates & Duration of Stay
Additional Address held in last 5 years - (include house / apartment number, cross, main road, city, state, pin code)*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Dates & Duration of Stay*
Home Phone

Area CodePhone Number
Cell Phone*
E-mail*
YesNo
Date*

MonthDayYear
Particulars*
Emergency Contact Name*
Contact Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Contact Phone*
Contact Email*
Relationship*
Contact Fax

EMPLOYMENT HISTORY
Please fill out this page as completely as possible, listing current or most recent first. Account for a minimum of 3 last employments.
Organization 1 (most Recent)*
Salary Particulars*
TOTAL CASH SALARY*
STOCKS (provide details like total nos., vesting details, & valuation, if listed)*
Please describe your primary responsibilities*
Reason for seeking alternate employment*
Date we can contact the company *

MonthDayYear
Organization 2*
Cost to Company (CTC)*
Please describe your primary responsibilities*
Reason for seeking alternate employment*
Organization 3*
Cost to Company (CTC)*
Please describe your primary responsibilities*
Reason for seeking alternate employment*

EDUCATION
Please fill out this page as completely as possible, listing current or most recent first. Account for a minimum of 2 recent / last institutes.
Institute 1 (most Recent)*
Institute 2*
Institute 3
ACHIEVEMENTS AND ACTIVITIES (Please list special skills, equipment, knowledge, activities, languages, academic honors, publications or patents you feel are relevant to the position desired)

Read the following statements carefully before signing this application

I certify that all information provided on this application and on my resume or other supplementary materials are true and correct. I acknowledge that any false statement or misrepresentation will be reason for refusal to hire or for immediate termination of employment at any time during the period of my employment.

I hereby authorize Radisys or its agents to investigate my background to obtain information concerning my abilities and desirability as an employee, and to verify the accuracy of information provided by me. In connection with this investigation, I authorize my former employers, the references listed, and all other individuals and entities to give Radisys or its agents, all relevant information with respect to my previous employment, work performance and character. I release all such persons or entities, Radisys and its agents from all claims and liabilities of any kind arising from any part of the investigation, the furnishing of or use of this information. I also authorize Radisys to release such employment information to its agents and employees who require such information to investigate or make a decision with respect to any matter pertaining to my employment.

I understand Radisys regards certain information to be confidential and/or proprietary and will require me to execute a Confidentiality Agreement as a condition of employment.

I am in agreement with Radisys’ policy of equal opportunity, which provides that all aspects of employment are without regard to age, ancestry, color, disability, marital status, medical condition, national origin, pregnancy and genetics, race, religion, sex, sexual orientation or veteran status.

I understand and agree that if employed by Radisys, my employment will not be for any definite period. I understand and agree that this employment relationship may not be changed except by a written agreement specifically for such purpose signed by an officer of the Company and I.

If hired, I would be able to submit proof of my legal right to work.

I have read and understand the foregoing statements and accept them as conditions of employment.
Signature*

Clear
Date*

MonthDayYear
Request, Authorization and Consent to Conduct Background Investigation (INFORMATION RELEASE & APPLICANT AUTHORIZATION)
Name of Applicant (CAPITAL)*

First NameLast Name
Current Address : (No., Cross and Main Road, Street name, City, State & Pin code)*
Previous Names Used*
Permanent Account No. (PAN #)*
List all previous home addresses lived in the past 10 years*
Date of Birth *

MonthDayYear
Signature*

Clear
Date*

MonthDayYear
For Radisys Use only
I hereby request and authorize Radisys India Pvt. Ltd. for purposes of determining my qualifications for employment with Radisys and for having access to Radisys proprietary information, to do a background investigation on me, which may include obtaining a report on me. I understand the information Radisys requests will be information bearing on my character, general reputation, personal characteristics, professional characteristics, compensation. The sources of information Radisys may obtain include, but are not limited to, references, educational records, prior and current employers, and criminal background records. I further understand that Radisys verifies the accuracy of information I provide to it as part of my application.

I authorize Radisys, upon request, to furnish a copy of this signed statement to any school I attend(ed), a present or former employer, a criminal justice agency or any other person or entity that may be furnishing information to Radisys in connection with its background investigation.

In addition, I hereby release and hold harmless Radisys, its officers, employees and agents, if they request information or documents, and any person, or public or private entity that may furnish information pursuant to this Request, Authorization, Consent and Release form, from any and all claims arising from such activities, including, but not limited to, claims for defamation, fraud, misrepresentation, intentional or negligent interference with prospective business relations or contract, breach of contract (including any settlement agreement), negligent or intentional infliction of emotional distress, employment discrimination, violation of public policy, or federal, state, or local statute, ordinance, or regulation, and any other potential claims, demands, damages, liabilities and / or actions of any kind whatsoever, whether known or unknown to me presently, that I may have, now or in the future. I voluntarily grant this release for purposes of supporting my application of employment with Radisys and based upon my desire to encourage Radisys’ consideration of my application.
Signature*

Clear
Date*

MonthDayYear
Should be Empty:

Radisys Employment Application Form

For Radisys Use only