Background Verification Form

Employee Code :03655H Employee Location: NOIDA

PERSONAL DETAILS
Name of Applicant !andator"# ASHISH SRIVASTAVA
S!name !andator"# SRIVASTAVA
"iddle !andator"#
#i!$t !andator"# ASHISH
"aiden Name : %
Ha&e yo e&e! 'een (no)n 'y
anot*e! name+
NO
Place of Birt$% L,C-NO.# Date of Birt$ /0012AN103405
Se6: "ALE Nationality: Indian
#at*e!7$ Name !andator"#
A8C8SRIVASTAVA
9a$$po!t No8
HO653::3
SSN No8
/"andato!y ;o! ,S add!e$$5
Home 9*one O;;ice 9*one "o'ile : 3354033333
Email id%
a$*i$*<telecom=>mail8com
Permanent Addre&& %'
1516, Vidhi Tower, Mahagunpuram, NH-24, near Columbia Asia Hospial, !ha"iabad,
#$ %$ - 2&1&&2
Same%
1516, Vidhi Tower, Mahagunpuram, NH-24, near Columbia Asia Hospial, !ha"iabad,
#$ %$ - 2&1&&2
City : ?HA@IAAAD State : ,89
9in Code : B0000B Nea!e$t Landma!( : near Columbia Asia
Hospial
Name o; t*e contact pe!$on at t*e add!e$$ : HE"A SRIVASTAVA
Relation$*ip o; contact pe!$on : .I#E
Landline No8 "o'ile No8 3B64B45<66
Nat!e O; Location: O)ned 9!e;e!!ed time o; t*e day ;o! condctin> t*e
&e!i;icationC i; any : AND TI"E
Re$idin> Since /"andato!y5: B003 Re$idin> Till / "andato!y5:Till Date
ED()ATION RE)ORD
ED()ATION RE)ORD (Start with the latest/ highest qualification; please attach photocopies
of the documents ) All fields are mandatory
Name &
Address of
School/College
/Institute
Name & Address of
ni!ersity its affiliated
"ype of
#egree/#ipl
oma
o$tained%
State &'(
for fulltime
and &)( for
part*time
within
$rac+ets
#ates Attended
'rom "o
,oll
Num$er/,egis
tration
Num$er/-.am
Seat num$er
HIMT, Greater
Noida
HI"TC Greater Noida,
Affiliated to U.P.T.U,
Lucknow
"CA/#5 2,LD
B003
2,NE
B006
030330<00B
?8N8L8D Ra$to>i
Inte! Colle>e
Alla*a'ad Aoa!d Inte!mediate/
#5
2ly
0335
2ne
033:
3B4:6<
"8A8V Inte!
Colle>e
Alla*a'ad Aoa!d Hi>*Sc*ool
/#5
2ly
0333
2ne
0335
5030B<
E!PLO*!ENT RE)ORD
If you are still employed in this organi/ation0 please fill in the date $efore which you would not li+e the
!erification to $e initiated in the &"o( column% If you are not sure or would li+e to intimate this date
later0 please write 1Still -mployed1
-mployer 2
Full Name
Emplo"ee
ID
From mm+""# To mm+""#
Add!e$$ C%B< C SEC E 53 C NOIDA P$one Num,er
City NOIDA State ,89 Cont!y
India
9o$tal Code B00300
2o' TitleF TECHNICAL O9ERATION
ANALDST
Rea$on o; Lea&in>: Sala!y
De&ignation So;t)a!e De&elope! #inal Sala!y /Annal CTC5
Super-i&or Name . Title /R !anager Name
Super-i&or 0& P$one Num,er /R !anager P$one Num,er
E!PLO*!ENT RE)ORD
-mployer 3
Full Name
Emplo"ee
ID
From
mm+""#
To mm+""#
Add!e$$ P$one Num,er
City State Cont!y
India
9o$tal Code
2o' Title Rea$on o; Lea&in> Contact 2o'
De&ignation #inal Sala!y /Annal CTC5
Super-i&or Name . Title /R !anager Name
Super-i&or 0& P$one Num,er /R !anager P$one Num,er
E!PLO*!ENT RE)ORD
-mployer 4
Full Name
Emplo"ee
ID
From
mm+""#
To mm+""#
Add!e$$ P$one Num,er
City State Cont!y 9o$tal Code
2o' Title Rea$on o; Lea&in>
De&ignation #inal Sala!y /Annal CTC5
Super-i&or Name . Title /R !anager Name
Super-i&or 0& P$one Num,er /R !anager P$one Num,er
E!PLO*!ENT RE)ORD
-mployer 5
Full Name
Emplo"ee
ID
From
mm+""#
To mm+""#
Add!e$$ P$one Num,er
City State Cont!y 9o$tal Code
2o' Title Rea$on o; Lea&in>
De&ignation #inal Sala!y /Annal CTC5
Super-i&or Name . Title /R !anager Name
Super-i&or 0& P$one Num,er /R !anager P$one Num,er
E!PLO*!ENT RE)ORD
-mployer 6
Full Name
Emplo"ee
ID
From
mm+""#
To mm+""#
Add!e$$ P$one Num,er
City State Cont!y 9o$tal Code
2o' Title Rea$on o; Lea&in>
De&ignation #inal Sala!y /Annal CTC5
Super-i&or Name . Title /R !anager Name
Super-i&or 0& P$one Num,er /R !anager P$one Num,er
E!PLO*!ENT RE)ORD
-mployer 7
Full Name
Emplo"ee
ID
From
mm+""#
To mm+""#
Add!e$$ P$one Num,er
City State Cont!y 9o$tal Code
2o' Title Rea$on o; Lea&in>
De&ignation #inal Sala!y /Annal CTC5
Super-i&or Name . Title /R !anager Name
Super-i&or 0& P$one Num,er /R !anager P$one Num,er
REFEREN)E VERIFI)ATION
REFEREN)E VERIFI)ATION
Note E T*e !e;e!ence p!o&ided $*old 'e c!!ently employed o! en>a>ed in a p!o;e$$ional acti&ity8
11Plea&e en&ure t$at t$e contact num,er& of t$e reference are acti-e num,er& and are reac$a,le for
-erification
REFERENCE (1)
(1)Full name of the Reference
(professional)
Telephone # and email ID
Organization
Relationship with the candidate Friend
REFERENCE (2)
(1)Full name of the Reference
(professional)
Telephone # and email ID
Organization
Relationship with the candidate
REFERENCE (3)
(1)Full name of the Reference
(professional)
Telephone # and email ID
Organization
Relationship with the candidate
Information Relea&e Form
To 2$om It !a" )oncern%
9lea$e p!int
Sa*GGGGGGGGGGGGGGGGGGGGG GGGGGGGGGGGGGGGG
La$t name #i!$t name "iddle name
I *e!e'y at*o!iHe Vendo! o! t*ei! !ep!e$entati&e$ to &e!i;y in;o!mation p!e$ented on my employment
application1!e$me and to p!oc!e an in&e$ti>ati&e !epo!t o! con$me! !epo!t ;o! t*at p!po$e8
I *e!e'y >!ant at*o!ity ;o! t*e 'ea!e! o; t*i$ lette! to acce$$ o! 'e p!o&ided )it* ;ll detail$
n o; my p!e&io$ employment !eco!d *eld 'y any company o! '$ine$$ ;o! )*om I p!e&io$ly
)o!(ed8 T*i$ in;o!mation $*old inclde t*e date$ o; employmentF t*e nat!e o; t*e po$ition
*eldC Idetail$ o; my $ala!y pon depa!t!eJ and an app!ai$al o; my pe!;o!manceC capa'ilitie$
and c*a!acte!8 In additionC plea$e p!o&ide any ot*e! pe!tinent in;o!mation !eKe$ted 'y t*e
indi&idal p!e$entin> t*i$ at*o!ity8 I *e!e'y !elea$e ;!om lia'ility all pe!$on$ o! entitie$
!eKe$tin> o! $pplyin> $c* in;o!mation8
n o; my Kali;ication1de>!ee /copy o; my ce!ti;icate$ attac*ed5
n in;o!mation in !e$pect to my c*a!acte! ;!om t*e !eco!d$ maintained 'y local at*o!itie$


Si>nat!e: Date:

Checklist
For Education Verification:
Clear cop of the degree certificate and final ear mar! sheet would "e re#uired
For Bangalore Uniersit!:
$ clear photo cop of "oth sides of the Degree Certificate (The re%erse side of the
certificate has some information which the uni%ersit would re#uire)
Copies of the &ar! 'heets()rade Card for all the ears of attendance*
+ame of the college through which the candidate has graduated*
For E"#lo!"ent Verification:
Clear ,hotocop of the relie%ing(e-perience certificates
.mploee Code of the organization where%er a%aila"le
For Cri"inal Verification
$uthorization letter dul signed " the candidate/ authorizing a third part to conduct a criminal
%erification*
&andator Re#uirement 0ist for Criminal 1erification*
Common &andator Re#uirement for all locations
1) ,hoto identit proof (2e would re#uire an one of the "elow mentioned documents*)
,assport cop (First/ &iddle and last page)
,an card
1oter3s identit card
Dri%ing 0icense
4) $ddress proof (2e would re#uire an one of the "elow mentioned documents)
Clear Ration card cop (First/ &iddle and last page)
,assport Cop (First/ &iddle and last page)
&T+0(5'.' "ill clearl stating the address/ wherein the %erification needs to "e conducted
$ttested cop of 0ea%e and 0icense agreement ($ll pages)
0etter from compan clearl specifing the permanent address
6ostel $ccommodation 7 $ttested cop confirming the current address on the 6ostel
letterhead*
,aing )uest $ccommodation 7 $ttested letter " the secretar or chairman of the societ
on a societ letterhead
8) Residing with a Friend 7 $ttested cop of the friends lea%e and license agreement 9 attested
cop issued " the Friend confirming the candidates address details
:) Contact details of the su";ect would "e re#uired*
For Cri"inal Background Verification
$s is the process followed " most of the police departments across India for criminal
"ac!ground %erification/ it is possi"le that the police authorities ma contact ou or %isit our
stated residence and at times e%en as! ou to present ourself at the concerned police station* It
is part of the standard %erification procedure
,lease do not gi%e in to an attempts at coercion " the authorities and in the e%ent of an
occurrence/ please inform our respecti%e human resource officials immediatel*