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A. P E R S O N A L D E T A I L S

1. Name :

2. Fathers name :

3. Date of Birth :4. Date of Joining Government Service:

5. Date of Joining/ Induction into ICAS:

6. Address:

Permanent(1)

Present(2)

For correspondence(3)

7. E-mail address :

Office(1)

Personal(2)

8. Phone Number :

MobileNo.(1)

Office TelephoneNo.(2)

Residence TelephoneNo.(3)

9. Languages known:

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10. Whether residing in Government : Yes / Noaccommodation

11. Home Town :

12. Marital Status : Married / Unmarried

13. Details of SpouseName of spouse

(1)

Date of birth

(2)

Nationalityof spouse

(3)

Designationif spouse is

working

(4)

Name &Address of

organization

(5)

Telephonenumber(Office)

(6)

Organisationtype

(7)

14. Details of children:

Name of children(1)

Sex(2)

Date of birth(3)

(i)

(ii)

(iii)

(iv)

15. Number of dependent members (other than wife and children):

16. Details of dependent membersName of dependent

(1)Sex(2)

Date of birth(3)

Relationship(4)

(i)

(ii)

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B. Q U A L I F I C A T I O N

Educational Qualification details:

Qualification

(1)

Discipline

(2)

Specialization

(3)

Year of Passing

(5)

Institute/ College/

University

(6)

Place / City

(7)

Country

(8)

Remarks

(9)12th

Bachelors

Masters

Others

Others

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Professional Qualification details:

Qualification

(1)

Year of Passing

(2)

Institute / Organization

(3)

Place / City

(4)

Country

(5)

Remarks

(6)

Note: In case of Educational / Professional Qualification over and above those mentioned in the Classified list 2011, youare requested to attach a photo copy of certificate of the Educational/Professional qualification proposed to be added.

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C. P O S T I N G D E T A I L S

1. (A) Present Posting:

Current office of posting

(1)

Whether in Cadre / Ex-Cadre(Deputation)

(2)

OfficeTelephone

Number

(3)

Office Fax Number

(4)

(B) Pay details :

Pay Band

(1)

Grade Pay

(2)

Personal

Pay

(3)

Current

Basic Pay

(4)

Date from

which GradePay beingdrawn

(5)

Remarks

(6)

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2. Posting History (Since joining ICAS):

Ministry

(1)

Posting Period Designation

(4)

Station

(5)

Experience(Give brief details)

(6)

Remarks

(7)

From

(2)

To

(3)

Add extra sheet if required

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D. T R A I N I N G D E T A I L S

DOMESTICName of Course

(1)

Institute Nameand Place

(2)

Course details orsubject covered

(3)

TrainingPeriod

(4)

Certificate / Diplomaobtained if any

(5)

ABROADName of Course

(1)

Institute Nameand Place

(2)

Course details orsubject covered

(3)

TrainingPeriod

(4)

Certificate / Diplomaobtained if any

(5)

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E. L E A V E D E T A I L S

Balance of Leave details (As on 01.01.2012) :

Earned Leave

(1)

Half Pay Leave

(2)

Child Care Leave

(3)

Details of Study Leave availed :

FromDate

(1)

To Date

(2)

InstituteName

(3)

Coursetitle

(4)

Subjectcovered

(5)

Score in%

(6)

Certificate/ Diplomaobtained

(7)

Signature: _____________

Name: ________________