CANDIDATE PERSONAL DATA SHEET

NAME :

DATE OF BIRTH :

FATHER'S/HUSBAND'S
NAME & OCCUPATION :

Date of
FAMILY DETAILS
: Name Birth / Occupation
(For P.F. / E.S.I.)
Age
Mother :

Spouse :

Brother

1) :

2) :

Sister

1) :

2) :
Daughter /
Name
Son
Children

1) :

2) :

BLOOD GROUP :

PRESENT ADDRESS :

PERMANENT ADDRESS :

CONTACT NUMBER E-MAIL

PTO.
DETAILS OF PREVIOUS EMPLOYMENT :

Duration Reporting to Salary (As

SL.
Organization Designation Job Profile per Form
No From To Name Designation Contact No.
16 of IT)
1

PTO.
REFERENCES :

1) Name :
Company Name :
Designation :
Address :

Ph.No. :

2) Name :
Company Name :
Designation :
Address :

Ph.No. :

Please find below the list of documents to be submitted on or before the date of joining :

1) EDUCATIONAL CERTIFICATE : Please tick (a) if submitted

* Diploma
* Graduation
* Post Graduation
* Others

2) DATE OF BIRTH CERTIFICATE :

3) EXPERIENCE CERTIFICATE :

a)

b)

c)

d)

4) DECLARATION OF FAMILY DETAILS (SELF, SPOUSE AND TWO (2) DEPENDENT CHILDREN)
FOR GROUP MEDICARE INSURANCE POLICY (FOR WHO ARE NOT COVERED UNDER E.S.I.) :

Occupation /
Sl. No. Name of the Insured Sex Date of Birth Age Relation Preexisting illnesses if any
Designation

Nominee for Medicare Policy (Please mention Nominee Name) :

5) Photograph :

Signature of the candidate

* Note : All the certificate copies should be duly attested by the Gazetted officer.