Employee Registration Form

Basic Profile

EMPLOYEE CODE To be entered by the College :

Mr/Ms/Mrs/
Full Name of the Employee Dr.
(As per Service Book or
HSC Certificate)
DATE OF BIRTH
(As per Service Book or
HSC Certificate)
GENDER M/F/Other

OFFICE ADDRESS

AADHAAR NUMBER
Married/Unmarried If married, Date of Marriage :
MARITAL STATUS
Yes/No
DOMICILE OF ODISHA
Indian/Others
NATIONALITY
Hindu/Muslim/Christian
RELIGION
YES/NO Blindness(B)/Low Vision(LV)
PwD (Person with Physical
If Yes, Category: Hearing Impairment(HI)
Disability)
Locomotor Diability(LD)/Cerebral Palcy(CP)
Ex-Servicemen YES/NO Date of Discharge :
Sports Person YES/NO National/International
SC/ST/OBC/SEBC/General
CATEGORY/GROUP
A+/B+/O+/AB+/A-/B-/O-/AB-
BLOOD GROUP
YES/NO If Yes, Mention the disease name:
CHRONIC DISEASES IF ANY
ORIYA/ENGLISH/HINDI
LANGUAGES KNOWN
NCC/NSS/Hostel Supt./Warden/ Admin Bursar/Acct. Bursar/ Admission
Additional Charges,If any
I.C/ PIMS I.C / Exam I.C
E-mail Address, If any
Family Profile
Name of Relation Date Marital Adhaar No. Mobile no. Dependent Chronic
the with of Status (Yes/ No) disease
member employee Birth (Married/ (Y/N)
Unmarried) If Yes,
mention
the name
of disease
Wife/
Husband

Address(Permanent & Present)

Permnent Address Present Address

STATE

DISTICT

PLOT/ROAD NO

CITY/TOWN/VILLAGE

WARD NO

PINCODE
 POLICE STATION

CONTACT NUMBER

Educational Qualifications
EXAMINATI INSTITUTE UNIVERSITY PASSOUT YEAR DIVISION/GRADE DISTICTION PERCENTAGE
ON PASSED OBTAINED
10th/HSC
PU
+2/Int.
+3/Degree
P.G/ MCA
M.Phil
Ph.D
D.Sc/D.Lit
B.Ed/
PGDCA
Other
(Note – For Examination Passed Options are 10/HSC,+2(IA,ICom,ISc),+3 (BA/BSc/BCom both Pass/ Hons)
PG,M.Phil,Ph.D,DSc./D.Lit. CPEd/BPEd/MPEd,LLB/LLM, B.Lib /M.Lib can be added in other qualification)

Service Particulars
DESIGANTION Advertisement Date of Nature of Appointment Date of Date of
No. with date Interview Appointmen Order No. Appointment Joining
t

(Note -For Nature Of Appointment select from options OPSC, Regularization 1986 , , Regularization 1989,Taken
Over , Adhoc ,Governing Body ,SSB ,Leave Vacancy ,By principal)

Posting Details
COLLEGE DATE OF DATE DISTRICT TRANSFER TRANSFER DATE OF POST HELD
NAME JOINING OF ODER No. DATE JOINING
RELIEVE
Promotion Details
CATEGORY OF DATE OF DATE OF JOINING ORDER NUMBER ORDER DATE
POST PROMOTION (in PROMOTED
POST)

Accounts Details
A/C HOLDER NAME
A/C NO
A/C TYPE Savings/Current
BANK/ BRANCH NAME
PRAN ACCT. NO
IFCS CODE
HRMS ID
PAN
GIS No
GPF/EPF /CPF NO
Emoluments Details
PAY TYPE
PAY BAND
BASIC PAY
GRADE PAY
OTHER ALLOWNCE
D.A
HRA
TOTAL GROSS PAY
PROFESSIONAL TAX
HOUSE RENT
GPF/CPF/EPF
CONTIBUTION
LIC/PLI CONTRIBUTION
GPF Advance
GIS Advance
Other Advance/Loan
IT DEDUCTION
TOTAL DEDUCTION
NET TOTAL
(N.B- Pay Type Must be selected from options among -UGC, State Scale ,Block Grant 488,Blockgrant 662,
Consolidated)

Training Details
YEAR TYPE UNIV/INSTITUTE FROM DATE TO DATE DURATION
NAME

(N.B- Type should be one among Orientation , Refresher , Sp.Training , As a resource person)

Ph.D/D.Sc./D.Lit Awarded
Degree Title Of Thesis Year of Registration Degree Awarding If Completed
University Yr . Of Award
Ph.D
D.Sc./D.Lit
Publications (Journals/Books)
TITLE Journals/ PAGE NO VOL NO YEAR ISBN/ IMPACT FIELD OF
Books ISSN FACTOR SPECIALIZATION

Books Published
Title of the Publisher year Type of Book Prescribed by
Book any University

Guidance Provided(M.Phil, Ph.D, D.Lit. and D.Sc.)

Course Name of Title Of the Year Univ. Regd. No Univ. Status
the Thesis Name
Student
 Res
earch Project Executed
Name of the Sponsoring Status Co-
Amount Year of
Project Agency approved Approval Investigator
if any

On Going/
Completed

Conference/Workshop/Seminar Attended
If Yes, Title
Name Paper/Poster  of  the Place From To Event
Paper/Poster Level
Presented

(N.B for Event Level Choices are State Level , National Level Or International Level)
Consultancy Provided
To Whom For What Duration

Awards Received (Other than Ph.D./D.Sc)

Award Name Award Year Sponsoring Puropse
Organisation