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
