Employee Details Required (* Indicates mandatory field)

Employee Id* (Kindly fill post confirmation from HR through email) 14389
Name as per Aadhaar* Nishan Poovaiah K K

Expansion of Initials (If any) / Surname (If not mentioned in Aadhaar Name)

Address as per Aadhaar card* 3-90, Cherala Srimangala Chettalli

Current Address * EWS, Lakshmikant Nagar, Hebbal 1st stage, Mysuru, Karnataka-570016

Personal Email Id* nishanpoovaiah@gmail.com

Primary Mobile Number* 8762023884
Alternate Mobile Number* (Mention your relation with the person) 8762549324 - Father

Personal Data

Age* 22
Date of Birth(DD/MM/YYYY)* 24/07/1999
Gender* Male
Marital Status* Single
Religion* Hindu
Passport Number
Pan Card Number* IOEPK0408G
Aadhaar Card Number* 5220 8492 0247
Universal Account Number (UAN) - If applicable
Previous company ESI Number (Insurance Number) - If applicable
ESI nominee name (Father / Mother / Spouse)
Family Details* (Please mention Father, Mother, Siblings, Spouse Details)

Sl. No. Name* Relationship* Date of Birth* Occupation*

1 Kariappa K P Father 16/02/1969 Planter

2 Rathi K K Mother 15/09/1977 Homemaker
3 Bishan Mandanna K K Brother 29/05/2001 Studying

Emergency Details* [ To contact in case of emergency]

Your Blood Group B+

Name of Parents/Guardian to be contacted during emergency (Mention your Kariappa K P - Father

relation with the person)*

8762549324
Contact Number of the above mentioned person(In case of emergency)*

Education Details* (Please mention all education details starting from highest full time degree)

Sl. No. Qualification with specialization* College Name* University Name* Year of Start* Year of end* Full time/Part Time* Backlogs/Pursuing (If any mention)* Percentage*

1 BE - ME Coorg Institue Of Technology VTU 2017 2021 Full time NA

6.62
2 PUC ST Annes Karnataka Board 2015 2017 Full time NA
72
3 SSLC Bharatiya Vidya Bhavan Kodagu Vidyalaya CBSE - 2015 Full time NA
7.8
Previous Employment Record* (All fields are mandatory if you had work experience before)

Sl. No. Company Name* Address* Permanent/Contract* Previous Designation* Date of Joining* Date of Exit* Company Contact detail* Last drawn Monthly Gross salary* Reason for leaving*

NA NA NA NA NA NA NA NA NA NA

References:* (Minimum 1 reference mandatory) Give any 2 references under whom you have either worked / received education from, or who knows you professionally. (Other than your friends and relatives)

Sl. No.
Reference Name Position held & Organisation Name Phone Number Years of Acquaintance
1 Thimmaiah A G HOD (Coorg Institute Of TEchnology) 9448648600 4 years
 Mode of Separation*
[Resignation, Termination,
Absconded, Closed Operation,
Other(Please Specify)]
NA