EMPLOYEE INFORMATION FORM

Date: 12/11/2024 ☒ New Form Employee ID Number: Click or tap here to

☐ Change/Update enter text.

PERSONAL INFORMATION

Full Name: Eleazu Onuajula Cajetan (SURNAME First name Middle Name)

Maiden Name/Former Names/Alias (If applicable): Click or tap here to enter text.

Address: 21 Adeboye Sholanke Avenue, Off Allen Avenue

Onigbongbo, Ikeja, Nigeria (LGA, City, Country)

Contact No. 1: 08036130915 Contact No. 2: 09044447583

Email Address: [email protected]

Date of Birth: 17/07/1979 Place of Birth: Owerri

Sex: Female ☐ Male ☒ State of Origin: Imo State

Marital Status:

Single ☐ Married ☒ Separated ☐ Divorced ☐ Widowed ☐

ACADEMIC QUALIFICATIONS

List from the most recent educational qualification

Name of Institution Degree Obtained Dates Attended Grades/Class of Degree

University of East London MSc 2022/2023

Second Class

Yaba College of
HND 2000 - 2002 Upper Credit
Technology

Yaba College of
Technology OND 1997 - 1999 Lower Credit
EMPLOYMENT HISTORY (FROM MOST RECENT)

Employment Company Name Address Function/Designation

Dates
Konstructum
18/02/2024 Contracting Coy Ltd
40 Ademola Adetokunbo Str. VI Project Delivery Lead
Enyo Retail &
15/07/2019 1 AP/Conoil Road Apapa
Supply Ltd

EMERGENCY CONTACT DETAILS

1. Name: Click or tap here to enter text.

Home Address: Click or tap here to enter text.

Work Address: Click or tap here to enter text.

Contact No.: Click or tap here to enter text. Email: Click or tap here to enter text.

Relationship: Click or tap here to enter text.

2. Name: Click or tap here to enter text.

Home Address: Click or tap here to enter text.

Work Address: Click or tap here to enter text.

Contact No.: Click or tap here to enter text. Email: Click or tap here to enter text.

Relationship: Click or tap here to enter text.

NEXT OF KIN DETAILS

1. Name: Click or tap here to enter text.

Address: Click or tap here to enter text.

Contact No.: Click or tap here to enter text. Email: Click or tap here to enter text.

Relationship: Click or tap here to enter text.

HMO Information

Principal

1. Hospital Name: Click or tap here to enter text.

Hospital Address: Click or tap here to enter text.

Contact No.: Click or tap here to enter text. Email: Click or tap here to enter text.

Spouse Details
 2. Hospital Name: Click or tap here to enter text.

Hospital Address: Click or tap here to enter text.

Spouse Name: Click or tap here to enter text.

Date of Birth: Click or tap to enter a date. Sex: ☐ Female ☐ Male

Contact No.: Click or tap here to enter text. Email: Click or tap here to enter text.
Child 1

3. Hospital Name: Click or tap here to enter text.

Hospital Address: Click or tap here to enter text.

Child’s Name: Click or tap here to enter text.

Date of Birth: Click or tap to enter a date. Sex: ☐ Female ☐ Male

Contact No.: Click or tap here to enter text. Email: Click or tap here to enter text.
Child 2

4. Hospital Name: Click or tap here to enter text.

Hospital Address: Click or tap here to enter text.

Child’s Name: Click or tap here to enter text.

Date of Birth: Click or tap to enter a date. Sex: ☐ Female ☐ Male

Contact No.: Click or tap here to enter text. Email: Click or tap here to enter text.
Child 3

5. Hospital Name: Click or tap here to enter text.

Hospital Address: Click or tap here to enter text.

Child’s Name: Click or tap here to enter text.

Date of Birth: Click or tap to enter a date. Sex: ☐ Female ☐ Male

Contact No.: Click or tap here to enter text. Email: Click or tap here to enter text.

REFERENCES – PAST EMPLOYER (Kindly fill in the HR details of your past employer)

1) Referee Name: Click or tap here to 2) Referee Name: Click or tap here to
enter text. enter text.
Company Name: Click or tap here to Company Name: Click or tap here to
enter text. enter text.
Designation: Click or tap here to enter Designation: Click or tap here to enter
text. text.
Company Address: Click or tap here to Company Address: Click or tap here to
enter text. enter text.
Contact No.: Click or tap here to enter Contact No.: Click or tap here to enter
text. text.

40 Adetokunbo Ademola Street, Victoria Island, Lagos, Nigeria.

 Email: Click or tap here to enter text. Email: Click or tap here to enter text.

REFERENCES – CHARACTER (please note that immediate family members cannot be referees)

1) Name: Click or tap here to enter text. 2) Name: Click or tap here to enter text.
Relationship: Click or tap here to enter Relationship: Click or tap here to enter
text. text.
Profession: Click or tap here to enter Profession: Click or tap here to enter
text. text.
Company address: Click or tap here to Company address: Click or tap here to
enter text. enter text.
Residential address: Click or tap here Residential address: Click or tap here
to enter text. to enter text.
Phone number: Click or tap here to Phone number: Click or tap here to
enter text. enter text.
Email address: Click or tap here to Email address: Click or tap here to
enter text. enter text.

BANK ACCOUNT DETAILS

Name of Bank: Click or tap here to enter Account Name: Click or tap here to enter text.
text.

Account type: Savings ☐ Current ☐ Account Number (Nuban): Click or tap here to enter
text.

PENSIONS INFORMATION

Name of PFA: Click or tap here to enter text. RSA PIN: Click or tap here to enter text.

Account Name: Click or tap here to enter text.

DECLARATION

I, Click or tap here to enter text., (SURNAME First name Middle Name) hereby declare that the above
information provided by me is true and correct.

Employee’s Signature:

Date: Click or tap to enter a date.

40 Adetokunbo Ademola Street, Victoria Island, Lagos, Nigeria.