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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