International Rescue Committee (IRC)
Apartment A4, 4th Floor, Navana Miru,
House 4B, Road 96, Gulshan-2, Dhaka-1212
Contact Number +88 (0)1847352626
www.rescue.org
Date:
To,
HR Lead
International Rescue Committee (IRC)
Cox’s Bazar, Bangladesh.
Subject: Regarding Joining.
As per your offer, I am joining as Covid-19 response in your organization today .
Therefore, I am requesting you to take my joining.
___________________________________________
Thank you,
Name: Hafsa Khanam Tamanna
Contract Number: 01885305405
Email: [email protected]
International Rescue Committee (IRC)
Apartment A4, 4th Floor, Navana Miru,
House 4B, Road 96, Gulshan-2, Dhaka-1212
Contact Number +88 (0)1847352626
www.rescue.org
BANK INFORMATION FOR SALARY & BENEFIT DISBURSEMENT
Those who already have an existing bank account, do not need to open a new account for salary purpose.
Employee ID: Click or tap here to enter text.
Employee Name: Hafsa Khanam Tamanna
Designation: Covid 19 response
Department: Health
Work Station: Teknaf Host Community
Date of Joining:
Bank Account Name: Hafsa Khanom Tamanna
Bank Name: Dutch Bangla Bank,Cox's Bazar
Branch Name: Cox's Bazar Branch
Bank Account Number: 1451510122849
Bank Routing Number: Click or tap here to enter text.
Employee Signature:
International Rescue Committee (IRC)
Apartment A4, 4th Floor, Navana Miru,
House 4B, Road 96, Gulshan-2, Dhaka-1212
Contact Number +88 (0)1847352626
www.rescue.org
PERSONAL INFORMATION FORM
Employee ID: Click or tap here to enter text.
Employee Name: Hafsa Khanam Tamanna
Sex: Female Date of Birth:
Blood Group: O (+) Religion: Islam
Father’s Name: Mr. Mohammad Zakaria
Mother’s Name: Mis. Delu Ara Begum
Permanent Address: Eidgah,Cox's Bazar
Present Address: Eidgah,Cox's Bazar
Other Phone Number Click or tap here to enter
Cell Phone Number: 01885305405
(if any): text.
NID Number: 3753578339
TIN Number: 145476371998
Driving License Number
No
(if any):
If Married, Click or tap to enter a
Marital Status: Single
Marriage Date: date.
Special Medical Condition
Click or tap here to enter text.
(if any):
International Rescue Committee (IRC)
Apartment A4, 4th Floor, Navana Miru,
House 4B, Road 96, Gulshan-2, Dhaka-1212
Contact Number +88 (0)1847352626
www.rescue.org
Emergency Contact Details
First Emergency Contact Second Emergency
Name: Mr. Zakaria Name: Click or tap here to enter text.
Relationship: Father Relationship: Click or tap here to enter text.
Pookkhali,Eidgah,Cox's
Address: Address: Click or tap here to enter text.
Bazar
Cell Phone No: 01825131535 Cell Phone No: Click or tap here to enter text.
Email Address: No Email Address: Click or tap here to enter text.
Do you have any relative who in IRC? ☒ Yes ☐ No
If Yes, Please Specify,
Name: Jannatul Ferdous Nusrat
Designation: Midwife
Department: Re-Productive Health
Relationship: Friend
I hereby confirm that my responses to the above questions are complete and accurate to the best of my
information and belief.
Employee Signature:
International Rescue Committee (IRC)
Apartment A4, 4th Floor, Navana Miru,
House 4B, Road 96, Gulshan-2, Dhaka-1212
Contact Number +88 (0)1847352626
www.rescue.org
ACKNOWLEDGEMENT OF RECEIPT OF IRC MANDATORY POLICIES
By signing below, I hereby acknowledge that:
I have received a copy of the IRC Way standards for Professional Conduct and other documents and
Policies related to the IRC Way.
I have received a copy of, read and understood the IRC Harassment-Free Workplace Policy, IRC
Child Safeguarding Policy and a copy of Policy for Gender Equality.
I have read and understood IRC’s 3 Core values (Integrity, Service & Accountability).
I understand that any employee who engages in conduct prohibited by these policies and procedures
will be subject to disciplinary action, up to and including termination.
Employee ID: Click or tap here to enter text.
Employee Name: Hafsa Khanom Tamanna
Designation: Midwife(Covid-19 response)
Department: Health
Date of Joining:
Employee Signature:
International Rescue Committee (IRC)
Apartment A4, 4th Floor, Navana Miru,
House 4B, Road 96, Gulshan-2, Dhaka-1212
Contact Number +88 (0)1847352626
www.rescue.org
BENEFICIARY NOMINATION FORM
Employee Details
Employee ID: Click or tap here to enter text.
Employee Name: Hafsa Khanom Tamanna
Designation: Midwife
Department: Health
Date of Joining:
I hereby authorize the management of IRC to pay all my dues in absence of me to my following nominee(s):
Seria Date of Benefit
Name Relationship NID/ Birth Certificate No.
l Birth (%)
1 Mr.Mohammad Zakaria Father 7794137807
Click or tap Click or tap
Click or tap here to enter Click or tap here to enter
2 here to enter to enter a
text. text.
text. date.
Click or tap Click or tap
Click or tap here to enter Click or tap here to enter
3 here to enter to enter a
text. text.
text. date.
Click or tap Click or tap
Click or tap here to enter Click or tap here to enter
4 here to enter to enter a
text. text.
text. date.
Click or tap Click or tap
Click or tap here to enter Click or tap here to enter
5 here to enter to enter a
text. text.
text. date.
Total
I declare that, the information that I have provided is accurate and complete. This declaration forfeits any other
earlier declaration made regarding my beneficiary nomination.
Employee Signature:
International Rescue Committee (IRC)
Apartment A4, 4th Floor, Navana Miru,
House 4B, Road 96, Gulshan-2, Dhaka-1212
Contact Number +88 (0)1847352626
www.rescue.org
DEPENDENT INFORMATION FORM
Employee Details
Employee ID: Click or tap here to enter text.
Employee Name: Click or tap here to enter text.
Designation: Click or tap here to enter text.
Department: Click or tap here to enter text.
Date of Joining:
Date of Birth:
Nationality: Click or tap here to enter text.
Marital Status: Choose an item.
If applicable, kindly fill the below information:
Dependent Information – Spouse Details
Spouse Name: Click or tap here to enter text.
Sex: Choose an item.
Date of Birth: Click or tap to enter a date.
Nationality: Click or tap here to enter text.
NID/ Birth Certificate
Click or tap here to enter text.
Number:
Date of Marriage: Click or tap to enter a date.
Contact Number (if any): Click or tap here to enter text.
International Rescue Committee (IRC)
Apartment A4, 4th Floor, Navana Miru,
House 4B, Road 96, Gulshan-2, Dhaka-1212
Contact Number +88 (0)1847352626
www.rescue.org
Dependent Information – Child (1) Details
Child Name: Click or tap here to enter text.
Sex: Choose an item.
Date of Birth: Click or tap to enter a date.
Nationality: Click or tap here to enter text.
NID/ Birth Certificate
Click or tap here to enter text.
Number:
Contact Number (if any): Click or tap here to enter text.
Dependent Information – Child (2) Details
Child Name: Click or tap here to enter text.
Sex: Choose an item.
Date of Birth: Click or tap to enter a date.
Nationality: Click or tap here to enter text.
NID/ Birth Certificate
Click or tap here to enter text.
Number:
Contact Number (if any): Click or tap here to enter text.
I hereby certify that the information set forth above is true and complete to the best of my knowledge.
Employee Signature:
International Rescue Committee (IRC)
Apartment A4, 4th Floor, Navana Miru,
House 4B, Road 96, Gulshan-2, Dhaka-1212
Contact Number +88 (0)1847352626
www.rescue.org
Declaration Form – Falsification of Information
By signing below, I hereby acknowledge that:
If it is discovered that any material information provided by me during the recruitment process is false
or misleading, or that information has been concealed or withheld, my application will be considered
for disqualification;
If discovered after an employment offer has been extended to me, that offer can be withdrawn; OR,
If false information is discovered after I have begun my employment with IRC, appropriate corrective
action will be taken, up to and including termination.
Employee ID: Click or tap here to enter text.
Employee Name: Hafsa Khanom Tamanna
Designation: Midwife
Department: Health
Date of Joining:
Employee Signature:
International Rescue Committee (IRC)
Apartment A4, 4th Floor, Navana Miru,
House 4B, Road 96, Gulshan-2, Dhaka-1212
Contact Number +88 (0)1847352626
www.rescue.org
DECLARATION FORM – CONFLICT OF INTEREST
A conflict of interest is defined as an interest that might affect, or might reasonably appear likely to affect, the
judgment, objectivity and/or conduct of IRC Staff in the performance of their work. This policy concentrates on
three principal areas in which conflicts of interest may arise and may serve to compromise the ability of IRC
Staff to faithfully carry out their duties. They include: (1) solicitation of IRC Staff for non-IRC related causes
and distribution of materials related to such causes; (2) employment of people with close personal
relationships; and (3) accepting outside employment and other related activities.
By signing below, I hereby acknowledge that:
I have received a copy of the IRC’s Conflict of Interest policy.
I have read and understood the policy.
I agree to comply with the policy.
I agree to report promptly any changes in the information reported on this form, or any new
information relevant to a conflict of interest.
I understand that any employee who engages in conduct prohibited by these policies and procedures
will be subject to disciplinary action, up to and including termination.
Please certify below that you either have nothing to report under the IRC’s Conflicts of Interest policy, or
describe below anything you believe could give rise to an actual or possible conflict of interest under the
policy:
☒ I have nothing to report.
☐ I have the following matters to report:
1. Please specify below any matters you have to report.
Click or tap here to enter text.
2. For the purposes of determining possible future conflicts of interest, please specify other nonprofit and for-
profit boards on which you and/or your spouse sit, and the name of your employer and any businesses you or
a family member own).
Click or tap here to enter text.
Employee ID: Click or tap here to enter text.
Employee Name: Hafsa Khanom Tamanna
Employee Signature:
International Rescue Committee (IRC)
Apartment A4, 4th Floor, Navana Miru,
House 4B, Road 96, Gulshan-2, Dhaka-1212
Contact Number +88 (0)1847352626
www.rescue.org
DECLARATION FORM – ANTI-MONEY LAUNDERING
By signing below, I hereby acknowledge that:
I have never been involved directly or indirectly, in money laundering process of any nature.
If it is discovered that the above mentioned information provided by me during the recruitment process
is false or misleading, or that information has been concealed or withheld, my application will be
considered for disqualification;
If discovered after an employment offer has been extended to me, that offer can be withdrawn; OR,
If false information is discovered after I have begun my employment with IRC, my employment
contract will be void with immediate effect;
If it is discovered that I have been involved in money laundering process of any nature after I have
received offer for employment from IRC or during my employment period with IRC, my employment
contract will be void with immediate effect.
Employee ID: Click or tap here to enter text.
Employee Name: Hafsa Khanom Tamanna
Designation: Midwife
Department: Health
Date of Joining: 30/082020
Employee Signature:
