CL/HR/CEIF

COLOUR LABELS LIMITED

Employee Information
Personal Information (attach copies of statutory documents)

Full Name:
Last First Middle Name

Address:

PIN No

NSSF No

NHIF No

Mobile Phone: Alternate Phone:

Email

ID No:

Birth Date: Marital Status:

Spouse’s Name:

Spouse’s
Contacts: Spouse’s Email:

Job Information

Job Title: Employee ID:

Supervisor: Department:

Work Location: Email:

Work Phone: Cell Phone:

Position joined
Date Joined: as:
CL/HR/CEIF

Academic and Professional Qualifications (attach copies of academic certificates)

Name of
Institution:

Educational Level:

From Month and

Year:

Grades Attained:

Professional,
Technical or other
courses attended:

Employment Record

Former Immediate
Employer before
Colour labels LTD:

Title of previous
job:

Date Employed
and Date service
terminated:

Reason for
Service
Termination:
CL/HR/CEIF

Record of family Members/Dependents-Children

NAME RELATIONSHIP DATE OF BIRTH

(DD/MM/YYYY)

Beneficiaries Details

NOMINATED NEXT OF KIN/BENEFICIARY OF YOUR DUES IN CASE OF YOUR DEMISE

(Indicate percentage against name)

Name: Name:
Address: Address:
Telephone: Telephone:
Relationship: Relationship:
ID /passport Number ID/Passport Number:

Name: Name:
Address: Address:
Telephone: Telephone:
Relationship: Relationship:
ID /passport Number ID/Passport Number:
CL/HR/CEIF

Persons to be notified in case of Injury, Emergency or accident

Full Names:
Last First Middle Name

Address:
Address

Physical Location:

Primary Phone: Alternate Phone:

Relationship:

Staff Commitment

DECLARATION OF SECRECY
I declare that I shall not in the course of my duties disclose any information classified as secret
and/or confidential in relation to the company’s business; or information that would be prejudicial
to the company’s interest, to the public, competitors or any unauthorized persons.

ANTI-CORRUPTION PLEDGE
I undertake not to engage in corrupt or fraudulent activities that may jeopardize the company’s
interests. I shall discharge my duties with honesty and integrity and shall not be unduly
influenced by anything or anybody nor shall I use my position for dishonest gain.
I confirm that I have read and understood the contents of the pledges and I am also clear that
the failure to comply with the said pledges may result in disciplinary action against me by the
management or any action that may be deemed fit.

Name

ID No.

Signed

Date

Witness Name ID No.

Sign Date

I …………………………………………..declare that the information given in my forms is

complete, correct and to the best of my knowledge:

Signature …………………………………………………..

Date ……………………………………………………….