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Unorganised Worker Registration Form
Registration For New Employee
A. Personal Information
Name*
Email
Gender*
Select Gender:
Male
Female
Transgender
Mobile Number*
Date of Birth* (as per Aadhar Card)
Aadhar No*
Marital Status*
Select Marital Status
Never Married
Married
Widowed
Divorced / Separated
Father Name*
Social Category*
Select Social Category
SC
ST
OBC
General
Blood Group
Select Blood Group
A+
A-
B+
B-
O+
O-
AB+
AB-
Differently Abled?*
Yes
No
Type of Disability*
Select Type of Disability
Acid Attack Victim
Hearing Handicapped
Mental Disability
Physically Handicapped
Speech & Language Disability
Spine Injury
Visually Handicapped
Disability caused due to Chronic Neurological Conditions
Disability caused due to blood related disorders
Dwarfism
B. Address
B-1. Current Address
Current Address*
Select
Urban
Rural
House Number
State*
Select State:
ANDAMAN & NICOBAR
ANDHRA PRADESH
ARUNACHAL PRADESH
ASSAM
BIHAR
CHANDIGARH
CHATTISGARH
DADRA & NAGAR
DAMAN & DIU
DELHI
GOA
GUJRAT
HARYANA
HIMACHAL PRADESH
JAMMU
JHARKHAND
KARNATAKA
KERALA
LADAKH
LAKSHDWEEP
MADHYA PRADESH
MAHARASHTRA
MANIPUR
MEGHALAYA
MIZORAM
NAGALAND
ORISSA
PONDICHERY
PUNJAB
RAJASTHAN
SIKKIM
TAMIL NADU
TELENGANA
TRIPURA
UTTAR PRADESH
UTTARAKHAND
WEST BENGAL
District
Block
Panchayat
Village
City
Muhalla
Pincode
Staying at Current Location [in Year]*
B-2. Permanent Address
Permanent Address*
Select
Urban
Rural
House Number
State*
Select State:
ANDAMAN & NICOBAR
ANDHRA PRADESH
ARUNACHAL PRADESH
ASSAM
BIHAR
CHANDIGARH
CHATTISGARH
DADRA & NAGAR
DAMAN & DIU
DELHI
GOA
GUJRAT
HARYANA
HIMACHAL PRADESH
JAMMU
JHARKHAND
KARNATAKA
KERALA
LADAKH
LAKSHDWEEP
MADHYA PRADESH
MAHARASHTRA
MANIPUR
MEGHALAYA
MIZORAM
NAGALAND
ORISSA
PONDICHERY
PUNJAB
RAJASTHAN
SIKKIM
TAMIL NADU
TELENGANA
TRIPURA
UTTAR PRADESH
UTTARAKHAND
WEST BENGAL
District*
Block
Village / City
Pincode*
C. Educational Qualification
Educational Qualification*
Select
Not Literate
Literate without formal schooling
Below Primary
Primary
Middle
Secondary
Higher Secondary
Diploma / Certificate Course
Graduate
Post Graduate & above
Technical Degree in Engineering / Technology
Technical Degree in Agriculture
Technical Degree in Medicine
Technical Degree in Crafts
Technical Degree in Other Subjects
D. Occupation & Skills
Do you have any Working Experience*
Select
Yes
No
Having Experience / knowledge in which Sector*
Select
Agriculture
Building Construction
Road Construction
Automobile
Cement Factory
Food and Beverages
Mining
Leather and Rubber Industries
Art And Craft
Gems And Jewellery
Health Services
Hospitality And Services
Production Related
Fabrication
Apparel and Textile Industry
Security Guard
Pharmaceuticals
Briquette
Power Energy
Retail Shop
Physical Work
Retail
Electronics and It hardware
Aerospace And Aviation
Domestic worker
Telecom
Beauty and wellness
Sports and physical
IT Department
Call Centre Executives
Tourism
Services
Repair
Management and soft skills
Fitters
Experience / knowledge in which Skill*
Skill
Total year of working experience
Any other Secondary Occupation
How did you acquire skills?
Select
Received formal vocational / technical training
Did not receive any vocational / technical training
Skills to be upgraded
Select
To receive formal vocational training
To receive formal technical training
Monthly Income
Select
Name Of Last / Current Employer
Phone number of Last / Current employer
Address Of Last / Current Employer
E. e-Shram Card Information
Do you have e-Shram Card*
Select
Yes
No
Want to register for e-Shram Card*
Adhar Linked Mobile Number*
Nominee Details
Nominee Name*
Nominee Date of Birth*
Nominee Gender*
Select
Male
Female
Transgender
Relation of Nominee with you*
Select
Bank Account Details
Bank Account Number*
Account Holder Name*
IFSC Code*
Bank Name*
Branch Name*