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