Epe – Linkuphcl

EPE BIO-DATA FORM

Title

Surname/ Last Name

First Name

Middle Name

Date of Birth

Marital Status

Religion

Nationality

State of Origin

Permanent Address

Email Address

Phone Number Staff

Profession

Hobbies

Next of Kin Full Name

Next of Kin Address

Relationship NOK

Phone Number NOK

Email Address NOK

Guarantor Full Name

Guarantor Address

Relationship with Guarantor

Guarantor Phone Number

Guarantor Email Address

Full Name Emergency

Address Emergency

Relationship Emergency

Phone Number Emergency

Email Address Emergency

Site and Location

Hiring Status

Name of Financial Institution

Account Name

Account Number

Bank Verification Number

Name of Pension Fund Administrator

Retirement Savings Account Number/PIN

Staff NIN Number

Tax Identification number (TIN)

Have you ever been convicted of Any criminal offence?

Details (If you selected yes above, kindly provide more details)

Upload Passport Picture (Maximum file size of 1MB, .jpg or .png files only)

Upload Signature (Maximum file size of 1MB, .jpg or .png files only)

Declaration
I hereby certify that all information on this form is correct at the time of submission. I understand that intentionally providing false information will lead to disciplinary action or termination of my appointment after I am employed.

Submitted