H.R.M.S.
Employee Data Form
(only for permanent employee)
(This form is also available on http://www.rayatshikshan.edu website in download section)
(All information in the form is necessary to fill correctly)
Employee Current Branch order Details:
• Profile Type : (Teaching / Non Teaching)
• Branch Region : ( CENTRAL REGION/NORTHERN REGION/RAIGAD REGION/
SOUTHERN REGION/WESTERN REGION )
• Brach Type : Junior College/Secondary School/Primary School/MCVC
• Branch Name : Current Branch Name
• Vacancy Type : Open / Reserved
if reserved mention Category (GEN/SC/ST/VJ/DT(A)/NT(1)/NT(2)/NT(3)/OBC/SBC/NB)
• Appointment Type : Probation / Permanent
If probation Duration From / / To / /
• Duration Remark (optional) :
• Appointment nature : Fulltime / Part-time
• Employee Type : Non-granted
• Appointment Approved by : Deputy Director / Zilla Parishad /Joint Director
• Approval Reference no :
• Approval Reference Date : / /
• Enter Latest Order Date( Senior Scale /Promotion/Transfer Date) :
• Current Branch Joining Date : / /
• Letter No: Letter Date : / /
• Resolution Ref No. (optional) : Ref. Date (optional) : / /
• Resolution Body (optional) :
• Current branch joining Designation :
• Current Scale:
• Acquire Qualification :
• Employee Name in (English) :
• Employee Name in (Native Language) :
• Gender : Male / Female
• Date of Birth : / /
• Religion :
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Appointment Information
• Submitted Documents : (Tick only)
Birth Certificate
Bonafide Certificate
Cast Certificate
Cast Validity
Character Certificate
Degree Marksheet & Certificate
Diploma Marksheet & Certificate
Disability Certificate
Eligibility Marksheet & Certificate
Experience Certificate
Medical Fitness Certificate
Original Marksheet & Certificate of 10th Std
Original Marksheet & Certificate of 12th Std
PG Degree Marksheet & Certificate
School Leaving Certificate
• Medical Exam Details :
Medical Exam Date : / /
Result of Medical Exam :
• Memos and Non-sanction Leaves :
No. of Memo for Non-sanction leaves :
No. non paid leaves :
• Disciplinary Action :
Type of Disciplinary Action : Major / Minor
Type of Disciplinary Action Taken : Debarred from Examination work /Suspension /Others
By Whom was Disciplinary Action Taken : College/ University/ Sanstha/ Board/ Others
Action Applicable Duration : From / / To / /
Action Revoke : No / Yes
If Yes, Revoke Date : / /
Revoke Details :
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Personal Information Details
• Personal Details :
• Employee Name in (English) :
• Employee Name in (Native Language) :
• Gender : Male / Female
• Date of Birth :
• Religion :
• Nationality :
• Marital Status : ( Single / Married / Divorced / Widow / Separated )
• Height (in centimeters) :
• Identity mark :
• Is the Name Changed : Yes / No
If Yes, give the reason : Willingly / After Marriage
Name Change Resolution Reference no :
Name Change Resolution Reference Date :
Previous Name :
Previous Name in Native Language :
• Mother’s Name (Full Name) :
• Mother’s Name in Native Language :
• Father’s Name (Full Name) :
• Father’s Name in Native Language :
• Nominee Name (Full name) :
• Nominee Name in Native Language :
• Nominated Person is :( BROTHER /DAUGHTER /FATHER/HUSBAND/MOTHER/SISTER/SON/WIFE)
• Permanent Address : English Native Language
State :
District :
Taluka :
Address:
At post :
City /Village :
Pin code :
Phone No with STD :
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Email ID :
Mobile No. :
• Is Present address same as Permanent address : Yes / No
• If no then Present Address : English Native Language
State :
District :
Taluka :
Address:
At post :
City /Village :
Pin code :
Phone No with STD :
• General Detail :
Previous Employee No.(Optional) :
PAN No.:
PF No.:
NSS No.(Adhar card) :
GR No :.
Bank Name :
Bank Account No :
• Passport Detail :
Passport Number :
Issue Date :
Valid up to :
Place of Issue :
State :
District :
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• Legal & Social Detail :
• Category : Open / Reserved
If Reserved then Category : (GEN/SC/ST/VJ/DT(A)/NT(1)/NT(2)/NT(3)/OBC/SBC/NB)
Caste :
• Physically Challenged : Blindness or low vision /Hearing impaired /
Locomotor disability or Cerebral Palsy
• Sport Participation : ( District /University/ Zonal/ State /National /International)
• Social Reservation Information :
Active-Serviceman/Ward of Active-Serviceman Deserted/Divorced/Widowed Women
Ex-Serviceman/Ward of Ex-Serviceman Freedom Fighter/Ward of Freedom Fighter
Kashmir Migrant Member of Earthquake Affected Family
Member of Flood / Famine Affected Family Member of Project Affected Family
Resident of Tribal Area Ward of Primary Teacher
Ward of Secondary Teacher
• Languages
Languages known :List
List of Languages
Sr. No. Language Name Speak Read Write
1 Bengali
2 English
3 Gujrathi
4 Hindi
5 Kannad
6 Malayalam
7 Marathi
8 Punjabi
9 Sanskrit
10 Tamil
11 Telugu
12 Urdu
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• Critical illness : ( Brain Tumour/ Heart valve replacement or repaired /Paralysis /Severe Lung
disease/Miningitis/ Stroke/ Open Heart Surgery )
Professional Information
• Qualification Details :
Pre-
Pre-SSC: Qualification I to IX- (only non teaching class IV)
SSC-
SSC - Qualification –S.S.C.
Marking System – Grade/Percentile/Percentage
Date of Passing – / /
Grade –
Class – (Distinction/First/Second/Third/Pass)
Board- Indian/Foreign
State-
Board Name-
School Name-
HSC-
HSC- Qualification – H.S.C.
Marking System – Grade/Percentile/Percentage
Date of Passing – / /
Grade –
Class – (Distinction/First/Second/Third/Pass)
Board- Indian/Foreign
State-
Board Name-
School Name-
Diploma : Qualification:
Marking System – Grade/Percentile/Percentage
Date of Passing – / /
Grade –
Level of Degree: (Advanced/Basic/Bachelor/Doctor/General/Master/Special)
Mode of Learning: (Regular/External/Open/Distance)
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Branch/Specialization:
Class – (Distinction/First/Second/Third/Pass)
University: Indian/Foreign
State-
University Name:
Name of College/Institute:
• Qualifying Exam : Eligibility Test (NET/SET etc.)
Qualification:
Marking System – Grade/Percentile/Percentage
Date of Passing – / /
Grade –
Degree :Qualification
:Qualification:
Qualification
(For Multiple Degrees Re print this page and fill information for each degree in separate
page)
Marking System – Grade/Percentile/Percentage
Date of Passing – / /
Grade –
Level of Degree: (Advanced/Basic/Bachelor/Doctor/General/Master/Special)
Mode of Learning: (Regular/External/Open/Distance)
Branch/Specialization:
Class – (Distinction/First/Second/Third/Pass)
University: Indian/Foreign
State-
University Name:
Name of College/Institute:
Special Subject:
Optional Subjects:
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• Previous Experience : ( Before appointment letter )
Profile Type : Teaching / Non Teaching
Employer Name :
Employer Address :
Date of Joining : / /
Date of Reliving : / /
Job Description :
• Other Skill known: (for Non-
Non-Teaching)
• Assessor Details
Details :
Assessor Type :(Examiner / Moderator / Paper setter)
Whether on Panel : Yes /No
Type : Internal / External
Code :
• Award Detail :
Award : (Sanstha/ State/ National/ International)
Award Title :
Year :
Award From
Award for
Award Detail :
Additional Information
• Publication Details
Details : ( If any)
• Publication Type : Book / Research Project
If Research Project then Research Type : Minor / Major
( Furnish information as per APPENDIX-
APPENDIX-A)
{ for APPENDIX-
APPENDIX -A download from www.rayatshikshan.edu}
• Conference Details
Details :(
:( if any)
• Nature of Participation : Conference Attended / Conference Organized
( Furnish information as per APPENDIX-
APPENDIX -B)
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{ for APPENDIX-
APPENDIX -B download from www.rayatshikshan.edu}
• Project Details
Details : (if any)
( Furnish information as per APPENDIX-
APPENDIX -C)
{ for APPENDIX-
APPENDIX -C download from www.rayatshikshan.edu}
• Participation : (if any)
• Participation in :
• Membership : Examiner/ Board of Studies /Faculties / Academic Council / Management or
Executive Council /Senate
• Worked As : Pro Vice Chancellor / Director of BCUD /Controller of Exam / Dean, Director
• Extra Curricular Activity : NSS Program Officer / Rector of Hostel / NCC Officer / Second
Lieutenant / Karmaveer Vidya Prabodhini ( Name of Project)
• Other Details : (For College Only)
• Part of NAAC Team : Yes / No
If Yes then Duration (From / / To / / )
Designation :
Provide Details :
• Oriented Courses attended :Yes / No if Yes then No. Oriented Courses Attended :
• Refresher Course attended :Yes / No if Yes then No. Refresher Courses Attended :
• Is recognize as Research Guide: Yes / No
if Yes Approve no. of University :
No. of Students guided for M.Phill :
No. of Students guided for Ph.D. :
No. of Students guided for MSC. PPPR/MBA/Med/Project :
• Is any Enquiry going on : Yes / No if Yes give Details :
• Sanstha Bodies :
• Life Member : Yes / No From / / To / /
• Life Worker : Yes / No From / / To / /
• Member of General Body : Yes / No.
• Member of Managing Council : Yes / No. From / / To: / /
• Member of Executive Committee : Yes / No. From / / To: / /
• Member of Higher Education : Yes / No. From / / To: / /
• Member of Co-ordination committee : Yes / No. From / / To: / /
• Member of Karmaveer Vidya Prabodhiani : Yes / No
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• Director / Member of Rayat Co-op Bank : Yes / No
• Member of Kutumb Kalyan Yojana : Yes / No
• Member of Sevak Welfare Yojana : Yes / No
• Member of Laxmibai Bhaurao Patil Patpedhi : Yes / No
• Member of Krutadnyata Nidhi : Yes / No Membership Starting Date : / /
• Paying 1% of Annual Package : Yes / No
• How much amount Employee Paying per month : Rs.
EMPLOYEE SERVICE HISTORY RECORD :
(Note : All records fill from Service Book )
A) Service Record Type : New Appointment – ( Fill the First Original appointment order details )
Service Record Type: Appointment
Branch Name: ____________________________________________________________________________
Disignation:_____________________________________________________
Scale:( Mention 4th/5th/6th pay scale) ______________________________________________________
Appointment Date: ____________________________ Joining Date: _____________________
Letter Ref No. ________________________ Letter Date: ______________________
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(Noe: For B/C/D records reprint this page)
B) Transfer Simple
Simple /Transfer Promotional / Transfer Reported/ Transfer
Transfer Administrative/
Transfer Placement (Fill these type records from this page.)
(Fill All Transfers
Transfers Records,
Records, print number copies of this page and fill all transfers records one by
one)
one)
Service Record Type: Transfer Simple
Branch Name: ____________________________________________________________________________
Joining Disignation:_____________________________________________________
Scale:( Mention 4th/5th/6th pay scale) ______________________________________________________
Transfer Order Date: ____________________________ Joining Date: _____________________
Order No:_____________________________
C) Promotions –
(Fill All Promotions Records,
Records, print number copies of this page and fill all Promotional records one
by one)
one)
Service Record Type: Promotion
Branch Name: ____________________________________________________________________________
Disignation:_____________________________________________________
Scale:( Mention 4th/5th/6th pay scale) ______________________________________________________
With Effect From date:____________________________
Letter No:___________________________ Letter Date: ______________________
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D) Scale Change – ( Senior Scale/ Selection grade etc.)
etc.)
(Fill All scale change Records,
Records, print number copies of this page and fill all
all scale change records
one by one)
one)
Service Record Type: Scale change
Branch Name: ____________________________________________________________________________
Disignation:_____________________________________________________
Scale:( Mention 4th/5th/6th pay scale) (mention name of scale)
__________________________________________________________________________________________
With Effect From date:____________________________
Letter No:___________________________ Letter Date: ______________________
I hereby declare, the above mentioned information is true to the best of my knowledge and
information. If in case, any information / document found incorrect, I am responsible for the same
and the liabilities of the same will on me.
Name of the Employee :
Signature :
I have personally verified the above mentioned information of the employee from his/her Service
Book and I assure that it is correct as per records.
Signature of Head of the Office of the school
Name of the School :
HEAD MASTER
Signature and Seal
D:Mahendra Desai/1-12
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