PERSONAL DATA SHEET

* Please read the instructions leaflet before filling the form. Photograph
Please fill in BLOCK letters. Size:
Please cross out the irrelevant cages. 3.5cm x 1.5cm

SERVICE: SLAS/TS/LS/PMAS/Drivers /OES

Appointment Letter No:

Combined Service
Personal File Number:

Personal Information

1. Name
1.1 Prefix/Title: Mr. Mrs. Ms.

1.2 Last Name:

1.3 Initials:

1.4 Names Denoted by the

Initials:

2. Gender: Male Female

3. Birth Information
3.1 Date of Birth: (YYYYMMDD)

3.2 Place of Birth:

4. Civil Status Information

4.1 Marital Status: Married Single Divorced Widowed
4.2 Married Date
(YYYYMMDD):

5. ID Card Information
5.1 NIC Number:

5.2 NIC Issue Date

(YYYYMMDD):

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6. Passport Number:

Sri Sri
Indian
7. Ethnicity: Sinhalese Lankan Lankan Burgher Malay Other
Tamil
Tamil Moor

Roman Other
8. Religion: Buddhist Hindu Islam Christian
Catholic Religions

9. Private Addresses
9.1 Permanent Address
Information
9.1.1 Permanent Address:

9.1.2 City/Town:
9.1.3 Divisional Secretariat:

9.1.4 District:

9.1.5 Postal Code:

9.1.6 Telephone:

9.1.7 Fax:

9.1.8 Mobile:

9.1.9 Personal E-mail:

9.2 Temporary Address

Information
9.2.1 Temporary Address

9.2.2 City/Town:

9.2.3 Divisional Secretariat:

9.2.4 District:

9.2.5 Postal Code:

9.2.6 Telephone:

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10. Emergency Information

10.1 Contact Person Name:

10.2 Relationship to Employee:

10.3 Address of Emergency

Contact Person:

10.4 Home T. P. No:

10.5 Official T. P. No:

10.6 Mobile No:

11. Employee Family/Dependent Information

11.1 Spouse’s Information

Name with initials Date of Birth Employment Information

YYYY:MM:DD
Ministry/Department/Company City/District

11.2 Dependent Information (Children and Blood Relatives)

Name Relationship Date of Birth School Information Any Kind of

YYYY:MM:DD Special
Name of the City/District Sickness
School

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12. Official Information
12.1 Name as per the
Appointment Letter
12.1.1 Initials:

12.1.2 Last Name/s:

12.1.3 Has the name been Yes No 12.1.4 If “Yes”, has the approval been obtained under
changed? Treasury Circular 394?
Yes No
12.2 Public Service

12.2.1 Appointment Date to

Public Service
(YYYYMMDD):
12.2.2 Date Assumed Duty
(YYYYMMDD):
12.3 Current Service

12.3.1 Appointment Date to

Current Service
(YYYYMMDD):
12.3.2 Date Assumed Duty
in Current Service
(YYYYMMDD):
12.3.3 Method of Absorption Merit Open Limited Other
Recruitment to
Current Service: If Other, please specify:

12.3.4 Medium of Sinhala Tamil English

Recruitment:

12.4 Confirmed: Yes No

12.5 Probation Period Extension

Information

12.5.1 Is Extended? (if relevant) Yes No

12.5.2 Under Which Clause E. II 15.5.1 11.9 11.10

was the Probation
Extended?
From Date To Date
12.5.3 The Period the
(YYYY:MM:DD (YYYY:MM:DD)
Probation was
extended under the
clause E.II 11.10:

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13. Exam & Promotion Information

1 2 3 4 5 6
Service Grade Exam Details Joined/ Backdated Date Exam (EB/Typing)
Promotion Date (YYYY:MM:DD) Completed
/Released Date
(YYYY:MM:DD)

Class 1 –

Class ii/i Interview

Dip. In G. Mgt
SLAS
Second Language

Class ii/ii
EB 2

EB 1
Special
Class –

Prom.E/Service
TS
Class 1
EB 1

Super Gd. –

Librarian Class i –

Class ii EB

Class iii EB

Super Gd. Supra-Exam

PMAS

i. GCS Class i EB
ii. Typist
iii. Steno
iii. SK Class ii EB
iv. BK
v. Shroff
Class iii
Typing Test

Class 1 –

OES
(KKS) Class 2 –

Class 3 EB

Class 1 –

Drivers
Class 2.b EB

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14. Employee Salary
Information
14.1 Designation:

14.2 Class:

14.3 Grade(Segment)

14.4 Salary Scale

14.5 Basic Salary (Annual):

14.6 Increment Date

(MMDD):

15 Contributing to W&OP: Yes No

If “Yes” W&OP Number:

16. Status of Appointment: Permanent, Permanent, Permanent, Contributory

Pensionable PSPF Pension

17. Workplace Information

17.1 Provincial Council:

(Provincial Council Information is to be completed only by SLAS officers

who are attached to Provincial Councils)
17.2 Ministry:

17.3 Department:

17.4 Sub Office:

17.5 Institution:

17.6 Official Phone:

Extension:
7.7 Fax:

17.8 Email:

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18. Service Records (Start from the first appointment to the public service)

Ministry/Department/Institute/Sub Office Designation District From Date To Date

(YYYY:MM:DD) (YYYY:MM:DD)

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19. Educational
Qualifications
th
19.1 Highest Educational 8
O/L A/L Degree Masters
Qualification: Grade

19.2 Only to be filled by

the OES/Drivers

19.2.1 School/Institute –
th
8 Grade:
th
19.2.2 Year – 8 grade:

19.2.3 Comments:

20. Ordinary Level Qualifications

Name of the
School/Institute:

Attempt 1 Year Attempt 2 Year

Y Y Y Y Y Y Y Y
Index Number: Index Number:

Subjects Grade Subjects Grade

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21. Advance Level Qualifications

Name of the
School/Institute:

Attempt 1 Year Attempt 2 Year

Y Y Y Y Y Y Y Y
Index Number: Index Number:

Subjects Grade Subjects Grade

22. Higher Education (Masters/Post Graduate Diploma/Degree/Higher Diploma/Diploma)

Qualification Name Qualification Institute/University Status Year

Stream

23. Professional Qualifications (FCA/CIMA/CIM/ACCA/ICASL/ICSA/BCS)

Qualification Name Qualification Institute/University Status Year

Stream

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24. Language Proficiency

Highest Examination
Language Reading Writing Speech Passed Date Achieved
(YYYYMMDD)

Sinhala 1 2 3 1 2 3 1 2 3

Tamil 1 2 3 1 2 3 1 2 3

English 1 2 3 1 2 3 1 2 3

Other 1 2 3 1 2 3 1 2 3

1 = Excellent 2 = Average 3 = Poor

25. Drivers Information (To be filled only by the Drivers)

25.1 Driving license
Number:
25.2 Date Issued
(YYYYMMDD):

25.3 Date of Expiry

(YYYYMMDD):

25.4 Class of Motor

Vehicle:

26. Translators Language Information (To be filled only by the Translators)

Languages Qualified for Sinhala/Tamil Sinhala/English Tamil/Sinhala Tamil/English

Translating:

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27. Verification of Information (To be filled by the PMAS Officer who handles the personal
files)

Director General of Combined Service

Mr / Mrs / Miss. ______________________________________________________________

is serving in this office. I hereby certify that the particulars specified in the above application
have been checked with the personal file and found to be correct. Accordingly, the application is
forwarded herewith.

Name of Subject Officer: ………………………………………………………………………………

Date: …………………………… Signature: ……………………………………………….

28. Verification of Information (To be filled by the Employee)

I do hereby certify that the particulars specified by the PMAS Officer (who handles my personal
file) in this form are true and correct.

Name of Employee: ………………………………………………………………………………

Date: …………………………… Signature: ……………………………………………….

29. For Office Use Only

Data Entered by: ……………………………………………………………………………………….

Date: …………………………… Signature: ……………………………………………….

Data Validated by: ……………………………………………………………………………………..

Date: …………………………… Signature: ……………………………………………….

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