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(Disabled Persons Employed return)
(See rule 40)

Quarterly return to be submitted to the Special Employment Exchange for the Quarter ended Name and Address of the Employer Whether Head Office: Branch Office: Nature of business/principal activity:

  1. 1(a) Employment:
    Total number of persons including working proprietors/ partners/commission agents/contingent paid and contractual workers, on the pay rolls of the Establishment excluding part-time workers and apprentices. (The figures should include every person whose wage or salary is paid by the establishment).

    On the last working day of the previous quarter On the last working day of the quarter under report
    Orthopaedically Handicapped Orthopaedically Handicapped
    Visually Handicapped Visually Handicapped
    Hearing Handicapped Hearing Handicapped

    Men with disability
    Women with disability

    (b) Please indicate the main reasons for any increase or decrease in employment if the increase or decrease is more than 5% during the quarter.
  2. Vacancies: Vacancies carrying total emoluments as per prevailing minimum wage per month and of over three months duration.

    (a) Number of vacancies occurred and notified during the quarter and the number filled during the quarter (Separate figures may be given for men with disability and women with disability).

    Number of vacancies which come within the purview of the Act
    Occurred Notified Filled Sources
    Local Special Employment Exchange General Employment Exchange (Describe the source from which filled)
    1 2 3 4 5

    (b) Reasons for not notifying all vacancies occurred during the quarter under report vide 2(a) above.....................
  3. Manpower Shortages:

    Vacancies/posts unfilled because of shortage of suitable applicants
    Name of the occupation of designation of the post Number of unfilled Vacancies posts Disability wise
    Essential qualification
    Essential experience
    experience not necessary
    1 2 3 4

    Please list any other occupations for which this establishment had recently any difficulty in obtaining suitable applicants

    Signature of Employer

The Employment Exchange,

Note: This return relates to quarters ending 31st March/ 30th June/ 30th September and 31st December and shall be rendered to the local Special employment exchange within thirty days after the end of the quarter concerned.

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