FORM No.15 SERVICE AND PAYROLL ADMINISTRATIVE REPOSITORY FOR KERALA (See Rule 13A Part -1, KSRs) Instruction: This form is required to be duly filled up and submitted by the employees while reporting for duty on fresh appointment. The Officer before whom the employee reports for duty and the appointing authority are required to countersign the duly filled up form submitted by the employee. After getting the form countersigned by the appointing authority, the Subject Assistant will feed the data into Service and Payroll Administrative Repository for Kerala and obtain Permanent Employee Number from the system and write it down in the box provided below for the purpose. Specimen Signature
Specimen Signature
Affix a recently taken passport size photo
Signature shall not touch the lines PART A (for Office use) Employee Code Department
Office
PART B: PERSONAL DETAILS (To be filled by the employee) Name (In CAPITAL letters Initials after the Name) Date of Birth
and Sex
Name of father Name of mother Nationality
State
Caste Category (General/SC/ST/OBC/OEC) Whether ex-servicemen? (Yes or No) Voter Identity Card Number
Religion Whether Physically handicapped (Yes or No)
Identification marks of the employee Height
PAN Number Ration Card Number 1. 2. Marital status (unmarried/married/ divorced) Printed from www.finance.kerala.gov.in
Spouse’s Name Spouse’s Religion
Spouse’s Caste
Whether inter religion/caste marriage? (Yes/No) Spouse employed in (Specify organization)
Whether spouse is employed
PART C: CONTACT DETAILS Present Address
Permanent Address
House No. and Name
House No. and Name
Street Name
Street Name
Place
Place
Pin
Pin
State
State
District
District
Taluk
Taluk
Village
Village
Phone No.
Phone No.
Home Town
Home Town
Mobile No.
E- mail address
PART D: RECRUITMENT DETAILS Source (PSC or other agencies) Method (Direct/By transfer) Advice Memo No. Whether District recruitment (Y/N) Serial No. in the advice memo Appointment Order No.
Type (General or Special recruitment) Scale of Pay Advice Memo date If District recruitment, specify the District Entry category (State service/ State subordinate service) Appointment Order Date
Printed from www.finance.kerala.gov.in
PART E: IF ALREADY WORKING IN GOVERNMENT, GIVE DETAILS Department
Designation
Relieving Order No.
Relieving Order date Earlier Recruiting Agency Earlier Advice Memo Date. Earlier Appointment Order Date
Office last worked Earlier Advice Memo No. Earlier Appointment Order No. PART F: EDUCATIONAL QUALIFICATIONS Course Title
Subject
University/Board
Institution studied
Class/ Percentage
Reg No. and Year
PART G: DECLARATION Declaration The information furnished by me in this joining report is correct to the best of my knowledge and is based on valid documents. I also hereby produce the original documents in respect of all the information given before the reporting officer for verification. I am also aware of the fact that penal action would be taken against me if any of the information provided by me is found fraudulent. Station:
Name:
Date:
Signature:
PART G: VERIFICATION (For office use) Verified the original documents and found eligible for admission to duty.
Name and dated signature of the Reporting Officer Admitted to duty, Employee details may be furnished into SPARK and PEN obtained.
Name and dated signature of the Appointing Authority Printed from www.finance.kerala.gov.in
Specimen Signature. Specimen Signature. Signature shall not touch the lines. PART A ... PART E: IF ALREADY WORKING IN GOVERNMENT, GIVE DETAILS ... The information furnished by me in this joining report is correct to the best of my ...
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