BACKGROUND VERIFICATION FORM
Name of the Candidate
Date of Birth
Nationality
Father’s Name
Candidate’s Mobile Number
Current Address
Period of Stay at Current
Address
Permanent Address
Period of Stay at Permanent
Address
Gender Male Female
Email
Highest Education Qualification
Degree/Diploma
Enrollment Number/Roll
Number
Year of Passing
University/Institute Name &
Location
Period of Study (From - YYYY To
– YYYY)
Course Attended Regular/Full Time Part Time Correspondence
Document Submitted
BACKGROUND VERIFICATION FORM
Employment 1
Company Name
Employment Period
Company Contact Number
Supervisor Name &
Designation
Supervisor Contact Number
HR Name
HR Contact No. & Email
Employee ID
Date of Joining
Date of Exit
Reason for Leaving
Nature of Employment Probation Permanent Contractual Temporary
Employment Type Full Time Part Time
Employment 2
Company Name
Employment Period
Company Contact Number
Supervisor Name &
Designation
Supervisor Contact Number
BACKGROUND VERIFICATION FORM
HR Name
HR Contact No. & Email
Employee ID
Date of Joining
Date of Exit
Reason for Leaving
Nature of Employment Probation Permanent Contractual Temporary
Employment Type Full Time Part Time
Employment 3
Company Name
Employment Period
Company Contact Number
Supervisor Name &
Designation
Supervisor Contact Number
HR Name
HR Contact No. & Email
Employee ID
Date of Joining
Date of Exit
Reason for Leaving
Nature of Employment Probation Permanent Contractual Temporary
Employment Type Full Time Part Time
BACKGROUND VERIFICATION FORM
Employment 4
Company Name
Employment Period
Company Contact Number
Supervisor Name &
Designation
Supervisor Contact Number
HR Name
HR Contact No. & Email
Employee ID
Date of Joining
Date of Exit
Reason for Leaving
Nature of Employment Probation Permanent Contractual Temporary
Employment Type Full Time Part Time
Professional Reference
Details Reference 1 Reference 2 Reference 3 Reference 4
Name
Designation
Organization
Relationship
Contact Number
Email Id
BACKGROUND VERIFICATION FORM
Letter of Authorization
I grant permission to "Zella Screenings Private Limited," the organization appointed by the employer, to
reach out to any former employers listed in the Background Verification form/Resume for the purpose of
conducting comprehensive background verification checks. This includes, but is not limited to, aspects
related to education and employment, as per the selection process requirements.
I provide my authorization to former employers, agencies, educational institutions, and other relevant
entities to share any information regarding my education and employment history. I release them from any
legal or ethical obligations related to the release of such information.
I affirm that the details provided in the Background Verification Form/Resume are accurate and based on
the best of my knowledge.
Mr./Ms./Mrs.
Name in Capital Letters Signature Date
Documents Checklist
Criminal Records Check Any clear Photo ID with full Address, Father’s name and Date of Birth
(Aadhaar Card)
Education Check Scanned copy for the Degree/Diploma or Final year Mark sheet
Address Check Same as Criminal Records check
Identity Check Any government approved document, Aadhaar Card, Pan card, Voter ID
& Passport
Employment Check Scanned copy of Relieving Letter/Service Letter/Experience Letter, Pay
Slip (Latest), Offer Letter or Appointment Letter
Professional Reference Immediate Reporting Manager’s Phone number, Designation and email
address
