Scribd
Upload
5 views

Employee Informatio1

Uploaded by

sai1990.sk78
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
5 views

Employee Informatio1

Uploaded by

sai1990.sk78
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
You are on page 1/ 1

EMPLOYEE INFORMATION

Paste Recent
PROFORMA – H
Colour Passport
(To be filled using English CAPITAL LETTERS only)
Sixe Photo

OFFICE NAME: ____________________________________________

1. EMPLOYEE NAME: ___________________________________________________________


2. DESIGNATION: ______________________________________________________________
3. SEX: MALE FEMALE OTHER
4. SALARY DETAILS GRADE_______ BASCI PAY___________ PAY Matrix Level______________
5. DATE OF RETIREMENT: _________________________
6. POSTING BLOCK NAME: ________________________________________________________
7. MOBILE NUMBER: ________________________________________________________
8. BLOOD GROUP : GROUP RH FACTOY (+/-)
9. PRESENT RESENDENTIAL ADDRESS: ____________________________________________________
10. HOME BLOCK NAME: ___________________________ HOME DISTRICT _______________________
FILL BELOW THE NUMBER AND NAME OF ASSEMBLY CONSITUENCY(AC) WHERE –

11. POSTED AC NO. AC NAME

12. HOME

13. PRESENT RESIDENT :


14. YOUR NAME IS ENROLLED AC NAME
PART NUMBER
SR. NO. OF VOTER LIST
BOOTH NO.
BOOTH NAME
EPIC NO.
OTHER DETAILS –

15. BANK DETAILS: BANK NAME BANK BRANCH


IFSC CODE ACCOUNT NO.

16. IS POSTED FOR 3 YEARS OR MORE IN LAST 4 YEARS IN THE SAME DISTRICT: YES NO

17. DATE OF JOINING IN THE DISTRICT: ________/_______/________

18. Is BLO: YES NO If Yes Then BLO AC Name___________ PART NO.__________

19. Is PWD (PERSON WITH DISBABILITY): YES NO IF YES THEN %______________

20 Is TEACHER: YES NO

21. IS Gazetted Officer: YES NO

22. Remarks: ___________________________________________________________________________

Signature of Head of the office with seal

You might also like