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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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ecpy Rereived

G45 Authorized Slgnatery

iEmp!*y,:e's Slg:latu:=;
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NLS FACILITY MANAGEMENT se-rviceE
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E-mail: nlsfrn20l9@gmail.com

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

22.Flace 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 ' ..
25.Far 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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!-ett F{and F!ain lmPressions

LeftTEiumb Right Ttrumb

.Rclted
Rolled irnpression irnPression

$EGNATURE OF TI4E EMPLOYEE:

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Disease, ir so iuinisrr ini o"tails

27. A.ny Criminal Caqes pending,
if so furnish the details

28. Proof of Residence ( Enclose i

Date:

Signature oiAtiestating Officer .

__Signature of Employee
Name: f{arne:.