PERSONAL RECORD
Passport photograph
[This form is to be completed in capital letters]
Employee ID Number:
Starting Date:
Position:
Assigned Client Company:
PERSONAL INFORMATION
Name:
Surname First Name Middle
D / M / Y
Gender: M F Religion Date of Birth
______________
Nationality: State of Origin Hometown
Local Government Area of Origin:
Personal Email Address:
National Identification Number:
Official Email Address:
Contact Address:
Tel:
Tel:
Residential Address:_
Tel:
Tel:
Marital Status: Spouse’s Name:
(Single, Married, Separated, Widowed)
Spouse’s Occupation
Spouse’s Daytime Address
Tel:
By completing this form, you hereby consent to the collection, use, and transfer, in electronic or other form, of your data as described in
the Nigeria Data Protection Act, 2023.’
Children: Names Date of Birth
D / M / Y
1. _________________________________________________ ____________________
2. _________________________________________________ ______________________
3. _________________________________________________ _______________________
4. _________________________________________________ ________________________
Next of Kin: Relationship:
Contact Address:
Tel:
Tel:
EDUCATIONAL QUALIFICATION
Schools attended: Period: Qualification:
_______________________________ ________________________ _______________________
________________________________ ________________________ _______________________
_________________________________ _________________________ ________________________
MEDICAL INFORMATION
Blood Group: (i.e. O+, A+) Genotype: (i.e. AA, AS, SS, SC)
Allergies: Diabetic? Yes No Epileptic? Yes No
Please indicate other diseases:
Hobbies:
By completing this form, you hereby consent to the collection, use, and transfer, in electronic or other form, of your data as described in
the Nigeria Data Protection Act, 2023.’
EMPLOYMENT HISTORY
Organization Position Period
1._______________________________ _______________________________ ______________________
2._______________________________ _______________________________ _______________________
3._________________________________ _________________________________ _______________________
4._________________________________ ________________________________ _______________________
EMPLOYMENT REFERENCES:
1. last Two Employers 2.
Name: Name:
Address: Address:
Phone Number: Phone Number:
Email Address: Email Address:
GUARANTORS:
1. Non-Family Guarantor 2. Family Guarantor
Name: Name:
Phone number: Phone number:
Address: Address:
Employer: Employer:
Office Address: Office Address:
Email Address: Email Address:
PENSION DETAILS
Pension Fund Administrator Name:
Pension Fund Administrator Pin. PEN:
By completing this form, you hereby consent to the collection, use, and transfer, in electronic or other form, of your data as described in
the Nigeria Data Protection Act, 2023.’
SALARY ACCOUNT DETAILS
Bank Name:
Bank Account No: For Office Use:
Yes No
Bank Sort Code: ID Card Issued
Home Located
Bank Branch: References Taken Up?
Access Card Issued?
Employee Signature: Utility Bill
Copy of Driver’s License
Copy of Int’l Passport
National ID card
By completing this form, you hereby consent to the collection, use, and transfer, in electronic or other form, of your data as described in
the Nigeria Data Protection Act, 2023.’
