Form for reporting of Job seeker Information

Sr. Particulars Description

No.

1. Name:

2. Father‘s Name:

3. Mother‘s Name:

4. Date of Birth:

5. Place of Birth:

6. Aadhaar No. of Jobseeker:

7. Mobile:

8. Gender: i. Male

ii. Female iii. TG

(Transgender)

9. Location: i. Rural

ii. Urban

10. Marital Status: i. Married

ii. Unmarried

iii. Divorced

iv. Widow

v. Widower

11. Category: i. General

ii. SC

iii. ST

iv. O.B.C.

12. Religion: i. Hindu

ii. Muslim

iii. Christian

iv. Sikh

v. Others

13. Reservation Category: i. PwD (Differently abled)

ii. Ex-Serviceman

iii. EWS

14. i. If Disability type: (OH/VH/HH/PwBD other)

differe

ntly

abled:

ii. Disability percentage:

a. Below 40%

b. 40-60 %

c. 60-80%

d. Above 80%

15. # Employment Status: i. Employed

ii. Unemployed

iii. Self- Employed

iv. Student

16. Language Known:

(Primary Language) Language Read Speak Write

1.

2.

3.

17. Physical Fitness:

i. Height (in cms.):

ii. Chest (in cms.):

iii. Weight (in kgs.):

iv. Eye Sight:

v. Partial Disability:

क. Blind:

ख. Deaf:

ग. Dumb:

18. Address with pin code:

19. Qualification:

(Starting from Highest Education)

Passed Exam Subject Boards/Uni./ Year Class Div. Certificate No.

Code Grade

School Name

Other Training/ Key Skills:

20. Medium of Education:

21. Specialization / Major:

22. Additional Course/Certificate

i. Name:

ii. Year:

iii. Issued by:

23. Professional Desired Employment:

24. Vocational Guidance: Yes/No

If Yes, Trade

Code:

25. # Work Experience

Sector Organisation Designati Specialization Period Experience

on Certificate

Code Type

From To Yes No

Central/State/

Central

PSU/State

PSU/Local

Bodies/

Autonomus/

Company/

NGO/

Partenship/

Proprietorship/

Others

26. Available to Join (in days):

27. To be filled by Ex-Serviceman:

i. Number:

ii. Joining Date:

iii. Release Date:

28. Reasons for leaving Job:

Self Employment (To be filled by the candidate interested in Self employment)

1 Are you currently self employed Yes/No

If Yes, Specify details:

2 (i) Loan availed previously for Self Employment: Yes/No

If yes,

क. Bank Name

ख. Branch (ii)

Defaulter:

If yes,

क. reason for late payment

ख. Balance amount

Yes/No

3 Are you interested in Self Employment: Yes/No

If yes,

Desired self Employment:

4 Are you or your family member defaulter of any Yes/No

finance institute or bank:

If yes,

i. Bank Name:

ii. Branch: iii.

Outstanding Balance:

All the above information is based on my inputs and is true to the best of my knowledge.

Note: # Furnishing of information to item no. (15&25) will not affect your prospects of

obtaining employment through employment exchanges.

## To be filled by those interested in seeking placement services in the Police Department,

Paramilitary Forces/Armed Forces etc.