BIO-DATA OF OUTSOURCED PERSON

1. Name of the Circle/Zone/Generating Station : Nalgonda Circle - TSSPDCL Affix Latest

Passport Size
2. Name of the Present Division/Sub-Division : Nalgonda /
Photograph
3. Name of the Out Sourced Person : (Duly attested
4. Fathers Name :
by the
(As per SSC Records) concerned
AD/DE)
5. Gender : Male

6. Category : Skilled
(Highly Skilled/Skilled/Semi-Skilled/Un-Skilled)

7. Date of Birth :
(As per SSC Records/Aadhaar Card (In Case of illiterate)

8. Date of Entry/Date of 1st Engagement :

(DD/MM/YYYY)

9. Details of engagement on outsourcing basis :

Adverse Remarks if any during work

Break Period if any (Furnish details)
Location of Work (Division/Circle)
Name of the Contractor/Agency

period (or) any action initiated

Agreement Period

EPF No. With UAN No

Agreement No.& Date

Agreement Value

Working Period
Nature of Work

ESIC No.
Sl. No

From

To

1
2
3
4
5
6
7
8
9

10

10. Community : BC - A

11. Sub-Caste : Chakali

12. PH Category (HH/VH/OH) : No Continued :: 2p ::

 :: 2 ::

13. Study Particulars (Attach Study Certificates) :

Class 4th Class 5th Class 6th Class 7th Class 8th Class 9th Class 10th Class
School
Name and
Address
District

14. The following documents are required to be furnished by the candidates who have not studied in any educational
institutions :

Sl.No Name of the document Document Number/Date Issued by

1 Birth certificate issued by
MRO / Municipality / Gram
panchayat
2 Health & Age certificate
issued by not below the
rank of Civil Surgeon of
district hospital
3 Residence certificate issued
by Tahasildar (Profama
enclosed)

15. Native District :

16. Address :

i) Permanent Address :

ii) Address for communication :

iii) Mobile No :

17. Educational Qualifications

(a) Academic qualifications :

(b) Technical qualifications :

Qualification Year of passing Total marks Marks secured

SSC
ITI ( )
Inter ( )
Diploma ( )
Degree ( )
PG ( )
Others ( )

Continued :: 3p ::
 :: 3 ::

18. Employment Exchange Registration No & :

Date, Name of the Employment Exchange

19. Whether convicted / involved / pending criminal case :

(Yes / No if Yes furnish details)

20. Whether He / She is working with other Private / Govt / PSU Organizations / Private Persons on Outsourced / Part time
basis (or) Engaged in any business activities apart from present work. If so furnish details.

Sl.No. Name of the Designation Period

organization From To

21. Voter ID Card issued by Election Commission :

(Specify Document No. and issuing authority)

22. Ration Card issued by Revenue Department :

(Specify Document No. and issuing authority)

23. Aadhaar Card issued by UIDAI :

(Specify Document No. and issuing authority)

24. Identification Marks

i) :

ii) :

25. Remarks :

Signature of the candidate

 :: 4 ::

DECLARATION

1. I hereby declare that the information and record[s] submitted as indicated above is / are true and correct to the best of my
knowledge

2. I hereby declare that I am native of Telangana by birth and domicile and residing in Village,

Mandal, District.

3. I hereby agree that my candidature may be summarily rejected and penal action may be taken, in case any of the
information / record [s] furnished above found to be incorrect or false and I will not make any correspondence in the matter
whatsoever and I will abide by the decision of the Corporation in rejecting my candidature.

4. I hereby declare that I was not convicted / involved in any criminal case.

Date: Signature of the Candidate

Place:

CERTIFICATE FROM THE FIELD ENGINEER

This is to certify that Sri s/o. is working as Highly Skilled/Skilled/Semi-Skilled/Unskilled

In Sub-Division, Division Circle through outsourcing

Under the contractor[s] from to against the agreements mentioned supra.

Asst. Engineer Asst. Divisional Engineer Divisional Engineer

 :: 5 ::

CIRTIFICATE OF RESIDENCE

[To be produced by such candidates who have not studied in any educational institution]

It is hereby certified (a) That Sri/Smt/Kum

S/o.W/o.D.o appeared for the first time for the Matriculation (S.S.C)

Examination in (Month) (Year).

(b) That he/she has not studied any educational institution during the whole/or part of the 4/7 consecutive
academic years ending with the academic years ending with the in which he/she first appeared for the
aforesaid examination.

(c) That in the 4/7 years immediately preceding the commencement of the aforesaid examination he/ she
resided in the following place / places namely;

Sl.No Village Mandal District Period

OFFICE SEAL:

STATION:

DATE: Office of Revenue Department no below the rank of

Mandal Revenue Officer holding independent Charge of a

Mandal.