Background Verification Form
Instructions: Please fill the form in BLOCK letters only and do not use any abbreviations
Fields Marked in (*) is mandatory.
Personal Information
*First Name
*Middle Name
*Last Name Please affix
your most
Former/Maiden Name recent photo
*Nationality here
*Gender Male Female
*Marital Status Single Married Others : ____________
D D M M Y Y Y Y
*Date of Birth
*
*Personal Landline No *Personal Mobile No.
*Identification Type * Identification No.
(Passport / PAN Card / Driving (Passport / PAN Card / Driving
Card) Card)
National Identity No./
Social Security No.
(If Applicable for Overseas
location)
Directorship details (If applicable)
*Company Name
Company/Operation Closed Functional Re-located
Company Current Status
Merged with
Company also Known as
*Complete Company
Address with Landmark
(Where candidate has worked)
* Company Contact No.
*City *State
D D M M Y Y
*Date of Joining
D D M M Y Y
*Date of Exit
Reason for Leaving:
DIN Number
*Documents submitted
Confidential
Current Address
*House / Flat Number
*Building Number & Name
Address Line 1
Address Line 2
Address Line 3
*City *Postal/ Zip Code
*State *Country
*Prominent Landmark
D D M M Y Y Y Y
*Period of From
Stay To D D M M Y Y Y Y
*Landline Number
*Mobile Number
Confidential
Permanent Address
Same As Above YES NO
*House / Flat Number
*Building Number & Name
Address Line 1
Address Line 2
Address Line 3
*City *Postal Code
*State *Country
*Prominent Landmark
D D M M Y Y Y Y
*Period of From
Stay To D D M M Y Y Y Y
*Landline Number
*Mobile Number
Confidential
Education Section
Instructions: Fields Marked in (*) is mandatory.
HIGHEST - Qualification 1
*Name of Qualification Obtained
* School/ College/Institute - Name
*School/ College/Institute - Location
School/ College/Institute - Contact No
*University / Board - Name
*University / Board - Location
Enrolment / Roll / Registration Number
M M Y Y
From
*Period of Study M M Y Y
To
*Year of Passing *Graduated Yes No Pursuing
*Course Attended Regular / Full Time Part Time Correspondence
Final Year Mark-sheet Degree Certificate (Along with backside if any)
*Documents Submitted Provisional Certificate Consolidated Marksheet
Other -: ________________
Qualification 2
*Name of Qualification Obtained
* School/ College/Institute - Name
*School/ College/Institute - Location
School/ College/Institute - Contact No
*University / Board - Name
*University / Board - Location
Enrolment / Roll / Registration Number
M M Y Y
From
*Period of Study M M Y Y
To
*Year of Passing *Graduated Yes No Pursuing
*Course Attended Regular / Full Time Part Time Correspondence
Final Year Mark-sheet Degree Certificate (Along with backside if any)
*Documents Submitted Provisional Certificate Consolidated Marksheet
Other -: ________________
Confidential
Employment Section
Note: Please start with your most recent employer
Instructions: Fields Marked in (*) is mandatory.
Current Employer 1
*Company Name
Company/Operation Closed Functional Re-located
Company Current Status
Merged with
Company also Known as
*Complete Company
Address with Landmark
(Where candidate has worked)
* Company Contact No.
*City *State
*Supervisor Name and
*Designation Designation
(As per Document)
Contact No.
Department
*Remuneration
*HR Name
(Last Drawn Salary)
*HR Contact No. and
*Employee ID
email ID
D D M M Y Y
*Date of Joining
D D M M Y Y
*Date of Exit
Reason for Leaving:
*Employment Type Full - Time Part-Time
*Nature of Employment Probation Permanent Contractual Temporary
Reliving Letter Experience Letter Service Letter Pay Slip
*Documents submitted
Other - _______________________
Third Party
(Name and complete
address)
(If through contract)
Can we contact HR /
Supervisor now (Y/N) if Yes No Date:_________
No, then date:-
Confidential
Employer 2
*Company Name
Company/Operation Closed Functional Re-located
Company Current Status
Merged with
Company also Known as
*Complete Company
Address with Landmark
(Where candidate has worked)
* Company Contact No.
*City *State
*Supervisor Name and
*Designation Designation
(As per Document)
Contact No.
Department
*Remuneration
*HR Name
(Last Drawn Salary)
*HR Contact No. and
*Employee ID
email ID
D D M M Y Y
*Date of Joining
D D M M Y Y
*Date of Exit
Reason for Leaving:
*Employment Type Full - Time Part-Time
*Nature of Employment Probation Permanent Contractual Temporary
Reliving Letter Experience Letter Service Letter Pay Slip
*Documents submitted
Other - _______________________
Third Party
(Name and complete
address)
(If through contract)
Confidential
Reference Section
Instructions: Fields Marked in (*) is mandatory.
Details Reference 1 Reference 2 Reference 3 Reference 4
*Name
*Designation
*Organization
*Relationship
* Contact No.
*Email ID
Confidential
