Government Employee Information

Use English unless otherwise mentioned. USE CAPITAL (BLOCK) LETTERS IN ALL
ITES
PART I - GENERAL INFORMATION (TO BE FILLED BY THE EMPLOYEE)
1. National ID No.
-
(In case of 13 digits ID please keep frst !o"es !lank#
$.
Name %
.
3. &ather's Name

.
. (other's
Name %
.
). *pouse
Name %
). +
,. -ender%
(.lease tick ( !)#
/. (arital *tatus %
(.lease tick !#. &or clarifcation0 refer to detail
instruction#
(1 (arried0 U1Unmarried0 21 2idow0 D1
Di3orce
4. &reedom &ighter
(.lease tick 50 if mentioned in
*er3ice 6ecord+7ook#%
8. 6eligion%
(.lease tick ( !)#
19. Date of 7irth% (:s in *er3ice 6ecord# 11. ;IN%
1$. .resent :ddress %
1$. a# Upa<illa+.* % 1$. !# .ost
=ode %
1$. c# District %
.lease tick (#0 if same as present address
13. .ermanent :ddress %
13. a# Upa<illa+.* % 13. !# .ost
=ode %
13. c# District %
1. >and .hone (?ome# % 1). (o!ile %
1,. E-(ail %
.hoto
;o !e .:*;ED
(Do N@;
*taple#
" U # $
I%lam &in'(i%
m
B('')i
%m
C)ri%tian
ity
Ot)er
%
$ay ont) *ear
- -
Si+nat(re of Employee Co(nter
Si+nat(re of $$O
(or of :@ in case of -a<etted
oAcer#
$ate, $ate,
PART II - SERVICE INFORMATION (TO BE FILLED BY AO/DDO/SELF)
1/. &irst Boining Date in *er3ice%
14. Designation at &irst :ppointment%
18. Name of =adre%
(Ignore if non-cadre#
$9. Boining Date in .resent .ost%
$1. .resent Designation % $$. =lass% (.lease tick
!#
1 + $ + 3 +
$3. a# Name of the oAce%
$3. !# .resent .lace of .osting %
$. Designation of DD@ (In case of non-ga<etted staC#%
$). Name of :ccounts @Ace%
$,. (inistrD+Di3ision
$/. Department%
$4. Nature of :ppointment (.ermanent+.ro!ation+;emporarD+:d-hoc#%
(.lease tick !#
$8. .resent *cale of .aD % 39. 7asic .aD %
31. Date of increment % 3$. -.& :ccount Num!er%