PERSONAL DATA FORM
NOTE: The length of this Form is planned to enable you to record important points
about your experience and to give the Company full details about yourself. The
Form is not a ‘test’, but particular attention should be given to the accuracy of details
supplied. Each staff has his/her peculiarities and this is recognized in the design of
this Form.
It is to be completed in your own handwriting and returned to DTML Office.
SURNAME. __________________________________________
FIRST NAME _________________________________________
OTHER NAME(S) _____________________________________
JOINING DATE _______________________________________
BANK NAME _________________________________________
ACCOUNT NO. _______________________________________
PFA NAME ___________________________________________
PFA NO._____________________________________________
EMPLOYEE CODE (To be filled by Employer) ___________________________
1. Entry Grade: Gross Salary:
2. Residential Address (Not P.O Box) Tel. No.
3. Permanent Home Address (Not P.O. Box):
4. Personal Email:
5. Sex (Male/Female): Title:
1
6. Place & Date of Birth: 6. Age Last Birthday:
7. Nationality: 8. State of Origin:
8. Home Town: 10. Local Govt of Origin:
9. Marital Status (Single, Married, Divorced, Religion:
Widow (er):
10. Name of Spouse: Maiden Name:
11. Address of Spouse (if different) Tel No.
12. Number & Ages of Children
S/No Name Date of Birth:
13. Name of Next of Kin: - Emergency Relationship:
Address: Tel No.
Name of Next of Kin – Beneficiary Relationship
Address: Tel. No.
14. List Any Disability/ Serious Illness that the
Company should be aware of:
2
15a. Height: 15b. Weight:
16. Leisure Interest/Hobbies:
17. Language(s) Spoken:
18. Are You Indebted to Anyone? Yes/No:
19. If Yes, to whom and state details:
20. Have you ever been convicted? Yes/No:
21. If yes, state reason(s) and date(s):
22(a) Educational Institutions Attended/Qualifications
Name of Institution Date Qualification(s) Obtained Grade/Class
*ATTACH PHOTOCOPIES OF ALL TESTIMONIALS & CERTIFICATES
22(b) Professional Qualification (Grade and Date)
________________________________________________________________________________
23. Work Experience (Names & Addresses. P.O Box is not acceptable).
NAME OF INSTITUTION COMPANY ADDRESS FROM/TO JOB SUPERVISOR’S
TITLE NAME & PHONE
(I)
3
(II)
(III)
24. Skills Acquired:
25. Motivation:
26. Hobbies:
27. Names & Addresses of Guarantors (P.O Box is not acceptable).
NAME ADDRESS PHONE NO
A]
B]
C]
28. Names & Addresses of Referees (P.O Box is not acceptable, Blood Relatives not included).
NAME ADDRESS PHONE NO
A]
B]
C]
29. DECLARATION: - I certify that the above information are true and complete. I also confirm that I am
not under any legal or moral obligation to the Federal/State/Local Governments, or to any other
institution or Firm. Finally, I understand that if any of the information given is discovered to be false
even after I have been employed, the Company reserves the right to terminate my appointment.
SIGNATURE: ____________________RH THUMB PRINT ________________DATE______________
