PERSONAL DATA FORM

Employee No: …………………………………

Surname: ………………………………………………………………………………………

First Name: …………………………………...Other Name ………………………………

Title: ………………………………………….. Marital Status :.……………………………….

Gender: ……………. ……………………………. Date of Birth: ………………………….

Disability: [Yes/No] …………………….

OTHER DETAILS

State of Origin: ……………………… Nationality: ……………………………………….

Religion: ……………………….

EMPLOYMENT STATUS

Designation: ………………………………………………………………………………

Department……………………………………………………………………………….

Date of Employment: ……………………………………………………………………

RESIDENTIAL ADDRESS

Home Address: ………………………………………………………………………..

City…………………………………………………………………………………….

State: ……………………………………………………………………………………
.
Country: ………………………………………………………………………………..

Home No: .………………………………Mobile No…………………………………..

NEXT OF KIN/DEPENDANTS

1. Surname: …………………………….Other Names: ……………………………

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 Address: ……………………………………………………………………………………

State: …………………………………. Country: ……………………............................

Phone number…………………………………………………………………………….

Relationship………………………….e-mail…………………………………………….

EMERGENCY CONTACT

1. Surname: …………………………….Other Names: ………………………………

Address: …………………………………………………………………………………..

State: …………………………………. Country: ……………………............................

Phone number…………………………………………………………………………….

Relationship………………………….e-mail……………………………………………

EDUCATIONAL HISTORY

Schools Attended Discipline Qualification Year Graduated

REVIOUS JOB HISTORY

Employer Position From To Summary of duties Reason for

Leaving

PERSONAL REFERENCE

Surname………………………………………Other Names…………………………

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Name of Company…………………………………………………………………….
Address………………………………………………………………………………..
Home No……………………………………Mobile No……………………………..
E-mail Address………………………………………

PREVIOUS EMPLOYMENT REFERENCE [LAST EMPLOYER]

Surname………………………………………Other Names…………………………
Name of Company…………………………………………………………………….
Address………………………………………………………………………………..
Home No……………………………………Mobile No……………………………..
E-mail Address………………………………………

PENSION
Pension Fund Administrator……………………………………………………………..
PEN Number: ……………………………………………………………………………….

BANK DETAILS
Name of Bank: …………………………………………………………………………………
Account Number: ……………………………………………………………………………..
Account Name: ………………………………………………………………………………..

MEDICALS
Blood Group………………………………….Genotype………………………………………..
HMO Hospital……………………………………………………………………………….

STAFF SIGNATURE: …………………………………. DATE: ……………………………