EMPLOYEE INFORMATION FORM
This is Mandatory to Fill Each Field
1. Full Name:
2. Department:
3. Designation:
RECENT
COLOURED
PHOTO
(Passport Size)
_____________________________________________
______________________Client Site (If Engineer) ____________________
4. Father/Husband Name____________________________ DOM (If married) ____________
5. Mobile No.:
_____________________Residence Contact No._____________________
6.
Date of Birth:
Day
Month
7.
Mal
e
Year
Female
Gender (Tick)
Un-married
Married
Divorced
8. Marital Status (Tick)
9. PAN No.
10. IT Declaration Form (Encl.): _______________________________
11. Present Address: _____________________________________________________________
_______________________________________________________________
12. Permanent Address: __________________________________________________________
_________________________________________________________________________
13. City (Permanent):
14. State (Permanent):
15. Pin Code (Permanent):
16. Email:
____________________________
17. Emergency Contact Person ____________________Relation with the Employee__________
Address of the Person (State, City)
18. References: a) ___________________________Email ID____________________________
1
EMPLOYEE INFORMATION FORM
This is Mandatory to Fill Each Field
Address of the Person (State, City)
______________________________________Contact No._____________________________
b) ____________________________________Email ID_____________________________
Address of the Person (State, City) ________________________________________________
__________________________________________Contact No.__________________________
19. Employee-Type:
____________
Regular
Contractual
20. Blood Group:
21. ESI Applicable __
_____
22. PF Applicable ________
______ _
__ _______ _ ESI No.
EPF No.___ ____________
__
23 Employee ICICI Bank A/C No.
24. Dependents Details (Mandatory)
S.
N
o.
Name
Relationship
With Employee
DOB of
dependent
Marital
Status
Gender
Permanent Address
Contact
Details
1
2
3
4
5
25. Qualification(s) Details (Mandatory)
Highest Education_:________
S.No.
Qualification
XII
_________________________________ __
University & College
( Fill both the details)
Year of
Passing(DD/
MM/YY)
Division
EMPLOYEE INFORMATION FORM
This is Mandatory to Fill Each Field
3
UG
PG
26. Experience(s) (in the table given on next page, if the space is inadequate attach a separate
sheet in the given format)
S.No
Organization
Department Designation
Start Date
End Date
Last
Salary
Drawn
27. Technical Qualification Certificates submitted ______________________________________
Remarks
Declaration
I hereby declare that the information given above is correct to the best of my knowledge. In case
of any discrepancy, Micro Clinic (I) Pvt. Ltd. reserves the right to take any disciplinary action.
Date:
Signature of Employee
Place:
To Be Filled by HR
Salary: INR _________________________
Date of Joining: _________________________
EMPLOYEE INFORMATION FORM
This is Mandatory to Fill Each Field
Approved by Branch Head / Management: ____________________________
Documents to be submitted at the time of Joining:
Updated CV
Duly filled & Signed New Joining Form
ID & Address Proof(Voter ID / Ration Card/ Driving License and PAN CARD)
Two Confirmations / References through mail at hrd@microclinic.in (who can be
contacted at the time of emergency)
Scanned copy of Original Educational Qualification Documents.
Relieving Letter from the previous employer
Last month salary slip from the previous Employer
Two Passport size Photographs
Duly filled & signed IT Declaration Form
HR Department..
hrd@microclinic.in
