ICICI Prudential Asset Management Company Limited
INSTRUCTIONS:
It is mandatory for you to complete the form in all respects. The information you provide must be complete and correct and the same shall
be treated in strict confidence & Verification process shall be initiated post joining.
The details on this form will be used for all official requirements should you join the organization
Employee ID Personal Information: ‐ Full Name (First, Middle, Last)
Date of Joining
Address Details with Contact Number (Latest 2 addresses) Period of Stay
1 From (mm/yy) To (mm/yy)
Current Address 2 From (mm/yy) To (mm/yy)
1 From (mm/yy) To (mm/yy)
2 From (mm/yy) To (mm/yy)
Permanent Address
Education Qualification
Note :
a) Certification courses need not be included in below form eg. NISM certification
b) Only completed courses to be included in this form (pursuing to be excluded)
College Name & Full / Part / Dates Attended Qualification
Sr. No University Name ID /Roll No
Address Correspondence From To Gained
Employment History
Employment History ‐ Current employer / Last Company worked
Note: Ensure that you are descriptive wherever necessary – e.g. If Co. is closed, do mention it. Employee Code/ ID/ Number is
mandatory. If your previous employer did not provide one, please mention and state reasons for the same. (Starting from your current
employer)
Note :
a) Work experience of less than 6 months, not to be included in below form. b) Internship experience not be included in below form.
Name of the Company & Contact No Address
Employee Code Designation
Permanent
Employment Period Temp Department
From To Contractual Manager's Name
Manager's Contact No
Manager's Email Id
Reason for Leaving
This document contains the private and confidential information of the signee. This is not meant for Public dissemination
Previous Employment History (2nd employer)
Name of the Company & Contact No Address
Employee Code Designation
Permanent
Employment Period Department
Temp
From To Contractual Manager's Name
Manager's Contact No
Manager's Email Id
Reason for Leaving
Previous Employment History (3rd employer)
Name of the Company & Contact No Address
Employee Code Designation
Permanent
Employment Period Department
Temp
From To Contractual Manager's Name
Manager's Contact No
Manager's Email Id
Reason for Leaving
Declaration and Authorization
I hereby authorize ICICI Prudential Asset Management Company Limited or a third party agent appointed by the Company) to contact any
former employers as indicated above & carry out all Background Checks not restricted to education & employment deemed appropriate
through this selection procedure. I hereby authorize ICICI Prudential Asset management Company Limited (or a third party agent
appointment by the Company) to collect, process, store, use, transfer, maintain my personal data, sensitive personal data (if required for
verification) in order to obtain employment verification report in connection to my application for employment. I authorize former
employers, agencies, educational institutes etc. to release any information pertaining to my employment/education and I release them from
any liability in doing so.
I confirm that the above information is correct to the best of my knowledge and I understand that any misrepresentation of information on
this application form may, in the event of my obtaining employment, result in action based on company policy.
Signature:
Date:
Name
This document contains the private and confidential information of the signee. This is not meant for Public dissemination
