Form 1: Employee Personal Information

Name of Department:

Employee Personal Information

Photo
First Name:

Middle Name:

Last Name:

Date of Birth:

Father/Mother/husband Name:

Gender: male/ female Martial Status:

Identity Mark:

**Mark the attached documents

Medical Fitness Character Certificate

Height (in cms):

Caste: Category:

Religion: Blood Group:

Home State: Home District:

Home Office Type: Home Office Name:

LTC Home Town: Nearest Railway St.:

Remarks (if any)

Employee office Details:

Current Designation: Current Office:

Current Cadre:
 Form 2: Employee Address Information

Name of Department:

Present Address Detail

Present Address

State District

Block Panchayat

Pin Code Phone Number

E-mail (if any) Mobile Number

Permanent Address Detail

Permanent Address

State District

Block Panchayat

Pin Code Phone Number

 Form 3: Employee Professional Information

Name of Department:

Joining Details

Date of Appointment: Order Number:

Office name at the time of initial joining in Deptt. :

Date of Joining in the Deptt.: Initial Designation:

Mode of Recruitment: Class:

Employee Type: Gazetted/ Non-Gazetted

Salary Details - (At the time of Initial Joining)

Basic Pay: Rs. Date of Retirement:

Deduction Type: GPF / CPS GPF/CPS Number:

GIS Member: YES / NO E-salary Code:

 Form 4: Employee Education Information

Name of Department:

 Education Detail
Basic
Name of Board/ Marks Obtained
Education Passing Year Stream Grade
University (In %)

Technical
Name of Board/ Marks Obtained
Education Passing Year Stream Grade
University (In %)

Professional
Name of Board/ Marks Obtained
Education Passing Year Stream Grade
University (In %)

 Training Details
In India
Training Type Topic Name Name of the Institute Sponsored by Date From Date To

Abroad
Training Type Topic Name Name of the Institute Sponsored by Date From Date To
 Form 5: Employee Family Information

Name of Department:

Family Details

Whether
Family Whether in Employee Code Name of department Member
Date of Dependent Employed
Member Relation Same Deptt. (If in the same (If other then Same E-salary
Birth (Yes/No) (State/centre
Name (Yes/No) deptt.) Deptt.) Code
/unemployed)
 Form 6: Employee Loan Details

Name of Department:

Loan Details

Loan Type Loan A/C No. Letter No. Sanction Date Sanction Amount Return Date Remark
 Form 7: Empolyee Service History
Name of Department:

Service History

Sr.No. Transaction To office To Which Class Order Order Date of Pay Name of the Area Type
Type Post Number Date Increment Scale other (Hard/Tribal/
Department Sub-
in case of Cader/None)
Deputation

Remarks (if any)

 Form 8: Employee Leave Detail

Name of Department:

Employee Leave Detail

Desig. of
Station Availing the Balance Till
Type of Action Leave Type From Date To Date Reason Remark Date
Leave LTC Sanctioning
Authority
Apply Cancel Yes No Yes No Yes No
 Form 9: Employee Departmental Proceeding
Name of Department:

Proceeding Detail
File Number: File Date:

Office where posted at the time of charges:

Designation: Proceeding Under Rule

Date of Suspension: Date of Revocation:

Proceeding:

Charges Details

Type of Charge: Charge Sheet No.:

Date of Appointing Inquiry Officer Name of the Inquiry Officer:

Date of Appointment of Presenting Officer Name of the Presenting Officer:

Designation of Appointing officer Designation of the Presenting Officer

Case Status

Case Status: Date of Decision:

Penalty/ Exonerated: Date of Penalty:

Appeal by officer: YES/NO Appellate Authority:

Date of Implementation:

Brief detail of the case decision:

 Form 10: Employee Old History

Name of Department:

Old Service History

Total
Name of Date of Order Service
Designation Total Service in Balance of Remark
the office Joining Number (In
months)
Hard Tribal Sub- Earned Half pay
Area Area Cader Leave leave
 Form 11: Employee Nomination Details

Name of Department:

Nomination Details

Name of the Nominee:

Relation with the employee: Type of Nomination:

Nomination %age: %

Nominee Address Detail

Present Address:

State: District:

Block: Panchayat:

Pin Code: Phone Number:

 Form 12: Employee ACR Details

Name of Department:

ACR Details

ACR Submitted by
Assessment Year Assest & Liabilities Assessment Period Remarks (if any)
(Name of the Officer)

Filed Not Filed From Date To Date