Effective Date: 25th Oct’19
BACKGROUND VERIFICATION FORM CHECK LIST (To be filled by the Client)
[This checklist is mandatory for clients where checks are to be specified for each case or where specific checks need to be
conducted from the among the contracted checks e.g. Education Check is mandated but it will depend on the Client whether
it is Highest, Latest or any other or Check Mandated is Highest Education and the candidate has completed 2 educations
which can fall into the category]
Dear Client,
Kindly tick (√) the checks to be verified. Also, ensure that the candidates provide the documents mentioned against the selected check
along with the duly filled JAF.
Important: Candidate is requested to ensure all documents submitted as proof are Self-Attested stating Date & Purpose. [State
purpose as ‘employment’]. Attestation should be done along the edge of the document ensuring no key areas of the document are
overwritten. This is in your own interest.
Self-attestation ensures your documents are only used for the purpose they are meant for and unauthorized use is dissuaded.
Address Check Documents Required
Address Previous ☐ Ration Card/ Passport/ Landline Telephone Bill/ Electricity Bill/ Rent Agreement/ Driving
Address Current Licence/ Voter ID Card against each address to be verified.
Address Permanent ☐
☐
Education Check
10th ☐
12th
Diploma ☐
Graduation Mark sheet/ All Semester Mark sheets/ Consolidated Mark sheet/Degree /Diploma/ Certificate
☐ against each education to be Verified.
Post Graduation
☐
☐
Employment Check
Current Employment
Number of Previous ☐
Employments
or Relieving Letter /Appointment Letter /Experience Letter /Last Salary Slip / Resignation Letter
__ against each employment to be Verified.
Number of years (to be
considered for previous
employments)
__
Reference Check
Current Professional Reference ☐ For Non-Fresher provide minimum 2-3
Previous Professional Reference Professional References from each Employment.
Personal Reference ☐ For Personal References: Persons of repute e.g.: Professor, Doctor, Gazetted Officers are valid.
☐
Database Check
Indian Database ☐
Global Database
☐
Criminal Check
Police Verification - Verbal ☐ Duly filled and signed CID Form, two Passport Size Photographs and Proof of Address mentioned
Police Verification - Written in the JAF.
☐
Photo ID Check ☐ Passport/ Driving Licence / Voter ID Card/ PAN Card
Passport Check ☐ Copy of first two and last two pages of the Passport
PAN Number Check ☐ Copy of the PAN Card
Character Check ☐
GAP Check ☐ Same as Documents required for Address (which need to be verified) and Criminal Verification
Company Check ☐ Provide any valid document on Company Letterhead with company address & contact details
etc.
CV Validation Check ☐ CV of the Candidate
Drug Test ☐
Confidential ARS/BE-Prod/FR/43 Ver 1.10
Effective Date: 25th Oct’19
Court Room Check ☐
Others (Specify) ☐
1
Confidential ARS/BE-Prod/FR/43 Ver 1.10
Effective Date: 25th Oct’19
BACKGROUND VERIFICATION FORM (to be filled by Candidate)
(Confidential when filled)
ATTENTION: The information you provide in the Background Verification Form (BVF) must be accurate as the same will be used for
verification purpose only. Therefore, you are advised to fill the entire BVF with utmost care and attention. Documents provided as
proof for the details in the BVF should match. Any mismatch of information/ documents or providing false information may result in
the rejection of your offer/termination of employment and action being taken as per the company policy.
Important: Candidate is requested to ensure all documents submitted as proof are Self-Attested stating Date & Purpose. [State
purpose as ‘employment’]. Attestation should be done along the edge of the document ensuring no key areas of the document are
overwritten. This is in your own interest.
Self-attestation ensures your documents are only used for the purpose they are meant for and unauthorized use is dissuaded.
HOW TO COMPLETE THE FORM
STEP 1 Y ou may need 15 – 20 minutes to complete the form.
STEP 2 D o read all the instructions very carefully. They contain important information about how to complete the application in every
respect and the documents that can be submitted as evidence (the information furnished by you would be incomplete without
documentary proofs).
STEP 3 Fill the form in BLOCK LETTERS with a B LACK ball point pen ONLY.
STEP 4 Sign the “Authorization Release Note” provided at the end.
Client Reference Number :
PERSONAL DETAILS
1. Name :
First Name Middle Name Last Name Please affix a
2. Father’s Name Passport size
photograph here and
First Name Middle Name Last Name
sign across.
3. Alias Name
First Name Middle Name Last Name
4. Date of Birth 5. Place of Birth 6. Gender 7. Marital Status
Town :
☐ Female ☐ Single
City :
D D M M Y Y Y Y Country : ☐ Male ☐ Married
8. Nationality
9. Contact Details:
STD/ ISD Code Phone(Residence)
Mobile Number: Alternate No.
Mail ID
10. Others
PAN No.(Enclose Copy)
Passport No.(Enclose Copy)
SSN/SIN/EIN No. if applicable
11. Are any criminal/civil proceedings pending against you before a court in India? If so, give name of court, case number and relevant
sections of Law.
Confidential ARS/BE-Prod/FR/43 Ver 1.10
Effective Date: 25th Oct’19
12. List of Enclosures – Proof of Identity ( Kindly tick (√) the relevent box below)
☐ Passport ☐ Voter ID Card ☐ PAN Card ☐ Driving License Others(Specify)
ADDRESS DETAILS
( Enclose a valid address proof of the address mentioned below
Please use a Photocopy of this sheet for Multiple Addresses)
ATTENTION: The information you provide in the Background Verification Form (BVF) must be accurate as the same will be used for
verification purpose only. Therefore, you are advised to fill the entire BVF with utmost care and attention. Documents provided as
proof for the details in the BVF should match. Any mismatch of information/ documents or providing false information may result in
the rejection of your offer/termination of employment and action being taken as per the company policy.
INSTRUCTIONS
1. Fill in the complete POSTAL Address. All fields are mandatory. Wherever not applicable, please write “NA”.
2. Keep your family members/ neighbors aware of the impending visit for address verification.
3. Duration of stay mentioned as ‘Till Date’ will be considered as date of signing the form.
4. During verification, if it is validated that you were not residing at the address on the duration mentioned, Verification would be
declared as NEGATIVE.
1. Address Type 2. Residence Type 3. Best day to visit 4. Best Time to visit
(Mon –Sat)
☐ Current ☐ Previous ☐ Owned ☐ Hostel/ PG ☐ Rental
☐ Permanent ☐ With Relative ☐ Parental
5. ADDRESS
Line 1
Line 2
Line 3
City District
State PIN Code
Nearest Landmark
Period of Stay
6. If you are staying in a Hostel/ PG/ Rented House, kindly provide the Name and Contact Details of your Landlord/ Owner/ Warden:
7. State clearly, if the entry is restricted or security Guard/RWA Society etc., is to be contacted for verification of the address provided.
8.List of Enclosures: Proof of address mentioned above (Kindly tick (√) the relevent box below).
☐ Passport ☐ Voter ID Card ☐ Rent Agreement Slip ☐ Latest Phone Bill ☐ Latest Electricity Bill
☐ Ration Card ☐ Driving Licence Others (Specify)
1. Address Type 2. Residence Type 3. Best day to visit (Mon –Sat) 4. Best Time to visit
☐ Current ☐ Previous ☐ Owned ☐ Hostel/ PG ☐ Rental
☐ Permanent
☐ With Relative ☐ Parental
5. ADDRESS
Line 1
Line 2
Line 3
City District
State PIN Code
Nearest Landmark
Period of Stay
Confidential ARS/BE-Prod/FR/43 Ver 1.10
Effective Date: 25th Oct’19
6. If you are staying in a Hostel/ PG/ Rented House, kindly provide the Name and Contact Details of your Landlord/ Owner/ Warden:
7. State clearly, if the entry is restricted or security Guard/RWA Society etc., is to be contacted for verification of the address provided.
8.List of Enclosure: Proof of address mentioned above (Kindly tick (√) the relevent box below).
☐ Passport ☐ Voter ID Card ☐ Rent Agreement Slip ☐ Latest Phone Bill ☐ Latest Electricity Bill
☐ Ration Card ☐ Driving Licence Others (Specify)
Confidential ARS/BE-Prod/FR/43 Ver 1.10
Effective Date: 25th Oct’19
EDUCATION DETAILS
(Enclose a valid education proof for the education mentioned below
Please use Photocopy of this sheet for Multiple Educations)
ATTENTION: The information you provide in the Background Verification Form (BVF) must be accurate and the same will be used for
verification purpose only. Therefore, you are advised to fill the entire BVF with utmost care and attention. Documents provided as
proof for the details in the BVF should match. Any mismatch of information/ documents or providing false information may result in
the rejection of your offer/termination of employment and action being taken as per the company policy.
INSTRUCTIONS:
1. Please fill the form starting with your most recent education first.
2. Please enclose a clear copy (both sides) of all Semester Mark Sheets AND Degree Certificates of the education stated.
3. If the degree certificate has still not been released then, enclose provisional certificate along with all Semester Mark Sheets.
1. Course Name 2. Program 3. Completed 4. Student ID /
Enrollment No./ Roll No.
☐ 10th ☐ 12th ☐ Graduation ☐ Full Time ☐
Part Time es
☐ Y
☐ Post Graduation ☐
Other(Specify)______________ ☐Correspondence ☐ No
5. College Name & Address
(for the above mentioned education)
6. University/ Board Name
7.Degree Name 8.Subject (Specialisation/ Major) 9. From 10.To (dd/mm/yy) 11.Graduation date
( Ex HSC, BSC, MA, MCOM) (dd/mm/yy) (dd/mm/yy)
12. List of Enclosures: Proof of education mentioned above (Kindly tick (√) the relevent box below).
☐ All Semester Mark Sheets ☐ Degree Certificate ☐ Provisional Certificate
Enclose copy of both sides of all semester Mark sheets and Degree certificate.
1. Course Name (Please tick one only) 2. Program 3. Completed 4. Student ID /
Enrollment No./ Roll
No.
☐ 10th ☐ 12th ☐ Graduation ☐ Full Time ☐
Part Time es
☐ Y
☐ Post Graduation ☐Other(Specify)______________ ☐Correspondence ☐ No
5. College Name & Address
(for the above mentioned education)
6. University/ Board Name
7.Degree Name 8.Subject (Specialisation/ Major) 9. From (dd/mm/yy) 10.To 11.Graduation date
( Ex HSC, BSC, MA, MCOM, BTech) (dd/mm/yy) (dd/mm/yy)
12. List of Enclosure: Proof of education mentioned above (Kindly tick (√) the relevent box below).
☐ All Semester Mark Sheets ☐ Degree Certificate ☐ Provisional Certificate
Enclose both side copy of all semester Mark sheets and Degree certificate.
13. State if there is any gap between your highest education and your first employment
(Application for experienced candidate)
☐ Yes ☐ No If Yes, state the gap period below State the clear reason of the gap below
Confidential ARS/BE-Prod/FR/43 Ver 1.10
Effective Date: 25th Oct’19
Confidential ARS/BE-Prod/FR/43 Ver 1.10
Effective Date: 25th Oct’19
EMPLOYMENT DETAILS
( Enclose a valid employment proof for the employment mentioned below
Please use Photocopy of this sheet for Multiple Employments)
ATTENTION: The information you provide in the Background Verification Form (BVF) must be accurate as the same will be used for
verification purpose. Therefore, you are advised to fill the entire BVF with utmost care and attention. Documents provided as proof
for the details in the BVF should match. Any mismatch of information/ documents or providing false information may result in the
rejection of your offer/termination of employment and action being taken as per the company policy.
INSTRUCTIONS:
1. Please fill the form starting with your most recent employment first.
2. Provide valid contact details for your Reporting Manager.
3. Wherein the company has ceased its operations, it is mandatory to mention the name and valid contact details of the Reporting
Manager / Owner.
4. State clearly if your Current Employment is from a Group / Associate Company of a Previous Employment OR your current or
any of your previous Reporting Managers are the same.
5. Provide atleast 2-3 References for each employment e.g: Reference of a Direct or Indirect Reporting Manager is valid.
6. Reference should not be a blood-relative/ family member.
CURRENT/ LATEST EMPLOYMENT
Kindly specify the date Post which the Current Employment should be touched? / /
Current Employment would be Verified post the date mentioned above. ANY escalation with reference to Current Employment being
conducted post this date will not be entertaned.
1. Nature of Employment 2. Self Employed 3. Current Designation 4. Dept. /Project
Official Title Functional Title
☐ Permanent ☐ Temporary
ull Time
☐ F ☐ Yes
☐ Agency
art Time
☐ P ☐ No
5. Payroll Company Name
(as stated on salary slip)
Of Head Office Of location where you have worked
Details
(leave blank if same as Head office)
Address
Phone Number
6. Deputed to Company
(Leave blank if same as in point 5)
Of Head Office Of location where you have worked
Details
(leave blank if same as Head office)
Address
Phone Number (Board line )
From To Date 9. Employee 11.CTC 12. Key Responsibility
Date (dd/mm/yy) Code (Per annum)
(dd/mm/
yy)
8. Employment Tenure
10. Grade
13. Reason for Leaving:
14. Reporting Manager Details from Current Company (Mandatory)
Name: Designation:
Is the Reporting Manager still a part of the company? ☐ Yes ☐ No Reporting Period
Company Landline/ Board line No. Personal Mobile No.
Confidential ARS/BE-Prod/FR/43 Ver 1.10
Effective Date: 25th Oct’19
Best Time to Reach:
Confidential ARS/BE-Prod/FR/43 Ver 1.10
Effective Date: 25th Oct’19
15. Provide Three References from your Current Company
Details REFERENCE 1 REFERENCE 2 REFERENCE 3
Name
Current Designation
Personal Mobile No.
Email ID
Best time to reach
16. List of Enclosures: Proof of Employment (Kindly tick (√) the relevent box below).
☐ Relieving Letter ☐Experience Letter ☐ Appointment Letter ☐ Resignation Letter ☐ Last Salary Slip Other
If knowledge of the document on the basis of which the verification would be conducted in the mentioned organizations then, it is
mandatory to provide the same document.
Confidential ARS/BE-Prod/FR/43 Ver 1.10
Effective Date: 25th Oct’19
PREVIOUS EMPLOYMENT
( Enclose a valid employment proof for the employment mentioned below
Please use Photocopy of this sheet for Multiple Employments)
1. Nature of Employment 2. Self 3. Current Designation 4. Dept. /Project
Employed
Official Title Functional Title
☐ Permanent ☐ Temporary ☐ Full Time ☐ Yes
☐ Agency ☐ No
art Time
☐ P
5. Payroll Company Name
(as stated on salary slip)
Of Head Office Of location where you have worked
Details
(leave blank if same as head office )
Address
Phone Number
6. Deputed to Company
(Leave blank if same as in point 5)
Of Head Office Of location where you have worked
Details
(leave blank if same as Head office
Address
Phone Number (Board line )
From Date To Date 9. Employee 11. CTC 12. Key Responsibility
(dd/mm/yy) (dd/mm/yy) Code (Per annum)
8. Employment Tenure
10. Grade
13. Reason for Leaving:
14. Reporting Manager Details of your Previous Employment (Mandatory)
Name: Designation:
Is the Reporting Manager still a part of the company? ☐ Yes ☐ No Reporting Period
Company Landline/ Board line No. Personal Mobile No.
Best Time to Reach:
15. Provide Three References from your Previous Employment (Mandatory)
Details REFERENCE 1 REFERENCE 2 REFERENCE 3
Name
Current Designation
Personal Mobile No.
Email ID
Best time to reach
16. List of Enclosures: Proof of Previous Employment (Kindly tick (√) the relevent box below).
Confidential ARS/BE-Prod/FR/43 Ver 1.10
Effective Date: 25th Oct’19
☐ Relieving Letter ☐ Experience ☐Appointment Letter ☐Resignation Letter ☐ Last Salary Slip Others
Letter
If knowledge of the document on the basis of which the verification would be conducted in the mentioned organizations then, it is
mandatory to provide the same document.
17. State if there is any gap between any of your employments
If Yes, state each gap period below State the clear reason of the gap below
☐ Yes ☐ No
PERSONAL REFERENCE DETAILS
(Applicable only in case of a Fresher)
ATTENTION: The information you provide in the Background Verification Form (BVF) must be accurate as the same will be used for
verification purposes. Therefore, you are advised to fill the entire BVF with utmost care and attention. Documents provided as proof
for the details in the BVF should match. Any mismatch of information/ documents or providing false information may result in the
rejection of your offer/termination of employment and action being taken as per the company policy.
INSTRUCTIONS:
1. Provide atleast 2-3 references.
2. Reference should not be a blood-relative/ family member.
3. For Personal Reference: Person of repute, Eg: Professor, Doctor, Gazetted Officer are valid.
Provide three Personal References (Mandatory)
Details REFERENCE 1 REFERENCE 2 REFERENCE 3
Name
Current Designation
Current Employer
Personal Mobile No.
Email ID
Best time to reach
Confidential ARS/BE-Prod/FR/43 Ver 1.10
Effective Date: 25th Oct’19
Please note that AuthBridge Research Services Private Limited will be conducting your employment background verification on behalf of
your employer. Given below is the Authorization letter, where you need to sign to authorize for your background verification. You have
right to deny and not sign the Authorization letter if you do not want to allow for verification.
AUTHORIZATION NOTE
Confidential ARS/BE-Prod/FR/43 Ver 1.10
Effective Date: 25th Oct’19
‘To whom so ever it may concern’
I authorize the Employer, AuthBridge Research Services Private Limited (“AuthBridge”) and its associated third parties (irrespective of
location) 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
The employment verification report may include information regarding my character, reputation, personal characteristics, Education
(Authentication of acquired or pursuing Degrees/Diplomas); Employment history; Credit history; court records, including criminal
verification records as permitted by law; National Identity Verification; Drug Test; Finger Print Verification; Address Verification
,references from professional and personal associates as maybe applicable and any other check as found relevant for the profile.
I, further understand and agree that the employment verification report may be obtained at any time and any number of times as
necessary before, during or post my employment.
I understand that some or all the information I have provided in this application form will be held as digitized or physical records as per
the data retention period, contractually agreed between the employer and AuthBridge.
I hereby authorize my all previous employers, educational institutions, consumer reporting agencies and other persons or entities having
information about me to provide such information to the employer, AuthBridge and its associated third parties for the verification
purpose.
I understand that the continuance of the employment or the offer of employment is contingent upon the outcome of the background
check conducted on me.
The proof of Identity enclosed and self-attested for reference. A Photostat, or any other copy, of this instrument bearing my signature
shall be equally legally valid as the original.
Note: 1. It is mandatory to duly sign the form on the space provided below or else the application form would be rejected.
2. If you are an EU (European Union) subject, you have the right to withdraw consent for processing of your Personal Data at any time by
contacting your employer/ organization initiating your Background verification. You also have further rights with respect to your Personal Data
processing, subject to conditions and restrictions set out in the applicable laws. To know more about EU data subject rights please visit
https://ibridge.authbridge.com/home/privacy-policy.
URL - https://ibridge.authbridge.com/home/privacy-policy
By signing this authorization, you also acknowledge that you have read, understand, and agree with the privacy policy found on our URL.
Signature: ________________
Name: ___________________
Date: ____________________
Place: ____________________
Confidential ARS/BE-Prod/FR/43 Ver 1.10
