Schedule_II FORM V : Service Card

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Schedule_II FORM V : Service Card

[Order 1]

Name of Estt. /Factory/Ticket/Token No.

1. Register Serial No.

2. Name

3. Specimen signature/Thumb impression.

4. Father’s or Husband’s Name

5. Sex

6. Religion

7. Date of birth

8. Place of birth

9. Date of joining

10. Details of medical certificate at the time of joining

11. Educational and other qualifications

12. Can read

13. Can write

14. Can speak

15. Height

16. Identification marks

17. Category of workman

18. Department

19. Details of family members

20. Permanent address

21. Local address

22. Quarter No.

23. Life Insurance policy no.

24. Provident Fund account no.

25. Nominee for gratuity

26. Nominee for pension, if any

27. Employees’ State Insurance no.

28. Training courses attended (details)

29. (Eligibility for higher jobs)

30. Proficiency tests passed

31. Employment history

Department	Token No.	Designation	Scale of pay	Joined	Left Reason

32. Absence periods

From	To	Reason	Medical report regarding suitability for continued employment

(i) Sick leave

(ii) Earned leave

(iii) Any other leave

33. Maternity benefit

34. Workmen’s compensation

Details of accidents

35. Details of disciplinary action

36. Promotions

(i) Details

(ii) Awards

(iii) Issue of certificate of commendation

37. Date of superannuation

38. Any other matter.]

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