Employee Joining Form
About Provana : Provana is a SaaS platform that gives leaders control over process-intensive
operations. We serve law firms, insurance companies, accounts receivable agencies and
networked enterprises in the US market that are tightly regulated by the CFPB and other
authorities. Provana is built on decades of experience in machine learning and natural language Paste a Photograph
processing and helps customers manage sensitive interactions, analyze unstructured data,
process personal information and ensure compliance. Provana is backed by a NYC-based
Fintech PE, most recently raising funds in November 2020. Learn more at www.provana.com.
Instructions to fill the form
Take the print out of this form.
All fields in the respective form should be filled with black gel pen and in BLOCK LETTERS only
Over writing and cutting in the form will not be acceptable.
If you have any doubt on any field in the form, kindly leave it blank.
Form-2 and declaration form are mandatory to meet PF compliances.
Employees, who are getting salary 21000 Gross Per Month or above need not to fill ESIC details. ESIC nominee should be from your
blood relations (Mother/ Father/ Spouse/Children).
Personal Details*
Date of Joining
Position Department
First Name
Middle Name
Last Name
Date of Birth Country of Birth
Email ID
H.No.
Street
Permanent Address
City Pin-code
State
H.No.
Street
Present Address
City Pin-code
State
Mobile No
PAN Number
Aadhar Number
Marital Status Single Married
Gender Male Female
Blood Group
Language Known
Vaccination Status Not Vaccinated First Dose Second Dose
Father's Name
Profession Date of Birth
Mother's Name
Profession Date of Birth
Applicant's Signature Date (dd/mm/yy)
Education Credentials*
Degree Year Stream University/Board Percentage Regular/Correspondence
10th
12th
Graduation
Post Graduation
Others
Work Experience (start from the last Job)*
Duration Emp
Organization Name Position Leaving Reason Last Working Last Drawn Salary
(in Months) Id
(location) Day
References for verification* Would request to share only professional references here(Reference of Reporting Manager, HR Person and colleague).
Name Designation Organization Contact Number Email ID
Emergency Contact Details*
Name
Relationship
Number
Address
Passport Details*
Do You have Passport? Yes No
If Yes, Please furnish the following details.
Passport Number
Validity From Till
Name (as per Passport)
Place of Issue
Indian Others
Nationality Wok permit valid till (in case of foreign nationals)
Applicant's Signature Date (dd/mm/yyyy)
ESIC details (If Applicable)
Date of Joining
First Name
Middle Name
Last Name
H.No.
Street
Permanent Address
City Pin-code
State
H.No.
Street
Present Address
City Pin-code
State
ESIC Nominee details
Name and Address of the nominee Relationship Date of Birth Share
Previous ESIC details
Fresher Experienced
If Experienced, Please share previous ESIC number.
Do you have your account in HDFC bank? If yes, please share the account No.
Yes No
Have you ever been convicted in any court? If yes please provide the details
Yes No
Are you physically challenged? If yes please provide the details
Yes No
Do you have any Relative / Friends working in Provana? Yes No
If yes, please provide below details. (Name, Emp ID, Designation, Department).
Name Emp ID
Department
Designation
Provana holds the right to conduct Criminal & Background check on your Professional & Educational background or drug
test through independent resources. In case, Background Verification check is negative and/or drug test is positive : Provana
holds the right to withdraw your offer or terminate your employment with immediate effect.
I hereby declare that all the information provided in this document is true. Misinterpretation by me in the form will lead to
disqualification of my candidature or termination of employment without notice or compensation
Applicant's Signature Date (dd/mm/yyyy)
Neither Provana, nor any third-party recruitment firm we work with, shall ever ask a candidate to pay at any stage to secure
employment with the Company. All candidates are considered on their merit and the selection of candidates is based on our
rigorous screening process. Any person or firm offering a position with the Company for a fee is considered an unprofessional
and unethical practice and any prospective employee or candidate facing such a demand from anyone is encouraged to never
accept it and immediately report it on ethics@provana.com with all relevant details
