DHANALAKSHMI SRINIVASAN INSTITUTE OF TECHNOLOGY

STAFF BIO DATA

FACULTY POSITION :

Date of Joining:

Present Address

Permanent Address

FULL NAME (BLOCK LETTERS)

Fathers Name:

Date of Birth & Age:

Nationality :

Sex:

Name and address of the person to

size
be informed in casePassport
of emergency
Colour Photo
Nativity :

Marital Status : Single / Married

Ph:

Ph:

Ph:

E.mail :
E.mail :
Name, Occupation & Address of Parents

E.mail :
Name, Occupation & Address of Spouse

Ph:

Ph:

E.mail :

E.mail :

HEIGHT :

WEIGHT :

POWER OF SPECTS (IF USING)

Driving License

Passport No :

ACADEMIC & PROFESSIONAL QUALIFICATIONS (SSLC Onwads)

Exam Passed

Institution

TRANING COURSES ATTENDED

Period
Course Title

Year of Passing

Major Subject

Conducted By

Class / Marks %

Sponsored By

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DHANALAKSHMI SRINIVASAN INSTITUTE OF TECHNOLOGY

Experience (Beginning with Latest Employment )
S.
No

Name & Address

of the employer

Designation

Period

LANGUAGES KNOWN (Underline mother tongue)

To read :
To write :
To Speak :

Responsibilities

Gross Salary

Reason for
Leaving

Physically disability / serious accidents if any:

Blood group:

Achievements in sports & Cultural activities

Membership in professional / cultural bodies

Details of publications / research papers

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DHANALAKSHMI SRINIVASAN INSTITUTE OF TECHNOLOGY

Have you been convicted by any court of law? If YES, details

PROVIDENT FUND NUMBER (If covered)

DETAILS OF CHILDREN (IF MARRIED) & DEPENDANTS

Name

Age

Relationship

Occupation

REFERENCES (PERSON NOT RELATED TO YOU, BUT KNOWS YOU FOR MORE THAN A YEAR )
NAME & ADDRESS

NAME & ADDRESS

NAME & ADDRESS

Ph:

Ph:

Ph:

I certificate that the above information is correct and complete to the best of my knowledge and belief. If , at any time, I am found to
have concealed any material information or even false information, my appointment shall be liable for summery termination without
notice or Compensation. I shall also abide by the rules and regulations of the institutions, which are in force from time to time
Place:
Date

Signature

For Office Use

Received and Verified By:

Principal

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