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1

EMPLOYEE INFORMATION SYSTEM

Govt. Medical College, Bhavnagar M.B.B.S.

CPF A/c No:

Name

Middle Name

Surname

Gender

Blood Group

Identification Mark

Marital Status

CASTE

Permanent Address City District, State Pin Telephone No.

Present Residential Address City District, State Pin Telephone No. E-mail LD Mobaila No.

Appointment Order No.

Appointment Order Date

Permenent/Temporary/Bonded/Adhoc

GPSC Confirmed

Seniority No.

2

Computer Literature (working Knowledge) Yes / No

Any Disability Yes / No

Qualification (XII onwards)

Examination Passed in Year Board/University Subjects

Examination Details

Examination Appeared On Date of Result No. of Trials Result

G.P.S.C.

Higher Level Hindi

Higher Level Gujarati

Others ( Please Specify)- CCC+ Exam

Previous Experience (Before Joining Gujarat Govt.)

To Name of Organization Designation Pay Scale

3

Details of dependents from the family (your family members)

Name Relation Date of Birth

Pay scale Details

Current Pay Scale

Basic Pay ( Basic+NPA)

Date of getting the current Basic Pay

Any Spl. Increment

Spl. Increment Amount

Tikoo Commission I received ( yes/no )

Tikoo Commission II received ( yes/no )

Tikoo Commission III received ( yes/no )

PAN No.

Bank Account No.

Bank Address

Aadharcard No.

Transfer Details

Present Designation

Present Office Address

Institute

Deptt.

Place

Phone

Current Transfer order received on

Are you currently working on deputation Yes/no

Name of office in which you are on deputation

Designation of Deputation Post

Date from which you are on present deputation

Any personal health constraints

Details of Services

Institute Address

Designation From To Deptt. Place

4

Advance details (only from Govt.)

Type of Advance Date of issue of Advance

Order No. Date of last installment

Amount Taken

Monthly Installment

MCA

HBA

GPF

Other

Passport details

Passport Number Issued from Expirary date

Property details

Type

Movable Immovable

On duty Training

Name From To Place

5

Professional interest

Interested in (Specify the field) Spl. Interest in

Member ship

Name of Organization Designation & Membership No.

Experience of handling (working in) any Disastrous situation (like any epidemic or flood or draught or e.quake)

Achievements: (in Job, Academic, Cultural, Sports, Others)

Award/Reward Year For

Personal Court case pending :- yes/no

Name of Court Case No. Year Present Status Other Details

Details of Inquiries

Inquiry No. Description Organization Date Result

From To

Details of break of service

From To For

Details of Nomination

Scheme Name of Person Nominated

Address Relation % of share

Date of birth

Name of Guardian

CPF

Pension/ Gratuity

Leave encashment

Insurance

6

Scientific Paper Published

Title Name of Journal Index No. National/International

Contribution in Textbook

Title of chapter Name of Textbook Editor Publisher

Paper/Poster Presented in National/International Conference

Title of Paper/Poster Name of organization Place Date

National of International Deputation

National/International

Name of Organization

Sponsoring Agency

Purpose of visit

Interventions done after returning

Duration & Year

Fellowship Awarded

Name of organization Subject Duration Year

7

Research Patented

Type of Research Patented Patent No.

Community Work Done

Type of work Details Vide Order No.

Name of State/National Health Programme

Type of Contribution Duration of Contribution

Organzation of conference

Name National/International Position Held

Administrative Experience

Organization Position Held Duration Year

I Certify that the information provided by me, ................................. is genuine and carefully entered.

Signature

_______________

NEW APPOINTMENT

1. Service Record – 2

2. Employee Information form – 4

3. Com. Appointment order – 4

4. Joing Report – 4

5. CTC – 4

6. School Leaving Certi. – 4

7. Caste Certi. – 4

8. Bahedhari Khat-4

9. Educational Qualification :-

MBBS/MD.Marksheet(Final) – 4

Medical Council Reg. – 4

10. Photograph – 5

11. Office Order – 4

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Joining.................... Dt..................

Vide Govt. notification No....................................................

Dt....................... Dr................................., ......................................... of

..............................department Medical College, .......................... has

been transferred & posted in Public intrest as a .......................of

......................department to This college he relieved from

........................Dt...................... after office hours and He has reported

to This office Dt.......................before office hours.

This office No...................................................Dt........................