Form - 6: PERSONAL RECORD FORM
1. Full name: ________________________
2. Date of birth: ______________________
3. Place of birth: ______________________
4. Date of employment: _________________
5. Identity card No: ____________________
6. Sex: Male _________ Female _____________
7. Address woreda _________ H.No. _______Kebele _____ Tel. ____________
8. Marital status: Single ____ Married: _____ Divorced: _____ Widow _______
9. Name of Wife/Husband ______________________ Address woreda
___________ H.No. ________ Kebele _____ Tel._____________
10. Children's names and dates of birth
NameSexDate of Birth
1 ___________ _____ ________________
2. ___________ _____ ________________
3. ___________ _____ ________________
4. ___________ _____ ________________
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11. Job Title/ Position at employment: _____________________
12. Department/program area at employment: ___________________
13. Salary/Allowance at employment: ______________________
14. Relative/Person to be contacted in case of emergency:
Name: _____________________
Position: ___________________
Address: ____________
Kebele: ______ H.No. _____ Tel. _________________ P.O.Box _____
15. Beneficiaries of pension/provident fund
NameAddress
1. _________________ _____________
2. _________________ _____________
3. _________________ _____________
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16. Educational Standard
Name of Attended Grade Field of studies Remark
Educational
From _____ completed
Institute
To _______ .
- Experience
Employer Address Duration Work position Monthly salary
From - To
Initial Last Initial Last
17. Transfer
Date From work Position To work place position
place
- Promotion, change of salary and allowance
First promotion Second Third promotion
promotion
Date
Position
Salary
Allowance
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18. Documents of acknowledgment and reward
Date Reason Type of Corresponding
acknowledgement benefit ,if any
and reward
19. Disciplinary measures
Date Type of disciplinary Action taken Remark
break
20.Additional information
______________________________________________________
Date of termination
______________________________________________________
Reason:
______________________________________________________
Employee Human Resource Manager
Name: ____________________ ______________________
Signature: _________________ ______________________
Date: ___________________ ______________________
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