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Clock No..... .... & Designatiorr ....
Name........
You are directed io report for cluty
hrs. You shali
continue your duty at ihe site as per the schedule explained to you.
Special lnstructiorrs {if any)
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CC:
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G45 Authorized Slgnatery
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NLS FACILITY MANAGEMENT se-rviceE
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E-mail: nlsfrn20l9@[Link]
Application Form
1 Name :
2 Father / Husband Name : Date of Birth :
3 Qualification: Email:
4 Sex: Male i lFemale Marital Status: Married' I I Unmarried
5 Tel. No With STD Gode : Mobile No :
6 Aadhar Number: Pan No :
7 Familv- Member Details Date of Birth Relationship
Name
I
9 2
,to
3
11 4
12 5
{3 Address Present Address Permanent Address
14 House/ Flat No & Name I
{5 StreeURoad/Lane :
{6 Area/Locality/Sector ;
17 Village/Town/Gity :
l8 State r Pin Gode:
{9 Nearest Police Station :
20 Nearest Post Office :
21 Work Experience:
3* Reference Person and Mob No:
23 OLD EPF Number: OLD ESI Number:
For Office Use
lntenliewed By .ri.r...r,rr.,rr,.r.. PoStgd at .....tr...r..r...r..r.......t.t
Unlform tssued : Shirt nons aer aro Slroes
[eant [uniardI I I I I R,,,ount
Rs.
Uniform Advance Amount Rs................ Joining Date : r....,,,..,....,r.r.
Signature of Field Officer / G. Manager Signature of the Applicant
Employee Bank Account Details
{. Name : -------- r-:r---:-
2. Bank Name:
3. Branch Address : ----
4. Account Number :------
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LEFT HAND FINGER IMPRESSION OF THE APPLIGANT
THUMB INDEX MIDDLE RING SMALL
Signature of the appticant
S*[utiosis {litdialF
## BIO-DATA OF EMFLOYEE
' 1 setr Declarition f
Organisation
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PasspGft-1r(),
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18. Bank Branch & Accoun'c No
19. Driving Llcense No.
20. Family / Parents and Gi'rildren Farticulars
Nan'le AE: Relationship
t{ari're :.
* AEe. Kelauronsnrp
$,lame ' "AEe . Relationship
l{ame Relaticnship
Pdarne Rblaticnship
21. 8{ative Place & Perrnanent Address:
Resi. Phone
[Link] of Residencefron'e East
Syrs-, with Door No. and
Phone h{o, other particulars
,,-.
tJnone No. Police Station:.
23. Present Address vtitti Door No.
Phone N Police Sfation:
24. idarnes of Bloqd Relatives . Erother and Sisters with Address:
1_
P[rone No. ' Bllobile Phone:
1-
P[rone tio. Ffrobile Phone:
. r ' ..
[Link] Reference, give two respectable personsName and Addresses:
!.
Phone No.
Phone t{o- _Mobi!'6 Fhone:
Ring FinEer LI'tt?e FinEer
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Ring Finger Li'dle Finger"
!-ett F{and F!ain lmPressions
LeftTEiumb Right Ttrumb
.Rclted
Rolled irnpression irnPression
$EGNATURE OF TI4E EMPLOYEE:
a
Disease, ir so iuinisrr ini o"tails
27. [Link] Criminal Caqes pending,
if so furnish the details
28. Proof of Residence ( Enclose i
Date:
Signature oiAtiestating Officer .
__Signature of Employee
Name: f{arne:.