Background Verification Form (India)
EMP No:
Please Print Clearly and Provide Complete and Accurate Information
Personal Details
Full Name
(First, Middle, Last) Lekha HM
Gender:
Female
Former Name(s) / Maiden Name (if applicable)
Date of Name Change
Current Address: #60 , 4th cross , Govt veternary Hospital Road, Behind Shivalinga Temple , Anjanapura main road ,
Konankunte, Bangalore 62.
Prominent Landmark
Period of Stay at Current Address
From: April/2012
To:Till date
Telephone (Home)
Telephone (Office)
Mobile Number
8095898948
NA
NA
Date of Birth (dd/mm/yy)
Fathers Name
Nationality
14/06/89
Muralidhar M
Indian
Passport No J9297945
E-mail ID
Marital Status
roselekha@gmail.com
Ms
PAN Card No AHUPL8300M
Educational Qualifications
(IMPORTANT: Copy of mark sheet and degree certificate MUST be attached)
Highest Education
(1)
College Name
Jnanabharthi College ,Bangalore University,Bangalore
College Address
Jnanabharthi College, Kengeri , Bangalore
University Name and
Address
Bangalore University , Kengeri , Bangalore
From
(month / year)
To
Jun/2009 Jun/2011
Type of degree
MSc
Graduated
Yes
Program
Full Time
Graduation date (month /
year)
Jun/2011
Student ID No:
Reg No :09TUSCS015
Subject Major
Computer Science
FAI-Bangalore
Employment History (Descending Order)
Details of Current or Last Employer
(1)
Company
Name:
Position Held
Cognizant Technology
Solutions India Private Ltd.
Software Designer and
Developer
& Department
Address (main office and branch where worked):
Telephone:
+(91)-80-42702000
Manyata Embassy Business Park, Manayata Tech Park,
Nagavara, Bangalore, Karnataka 560045
Employment Period: (DD/MM/YY)
Supervisor
Contact Details & Designation
HR Contact Details
& Designation : NA
From 18/08/2011
To Till Date
Shilpa , Manager
Off:
Cell:
Res:
Employee Code: 303348
Ph num: 9886781710
Whether employment is of permanent or temporary nature - Permanent
Agency Details (if temporary or contractual)
NA
Responsibilities:
NA
Remunerations
NA
Page 2 of 5
Reason(s) for Leaving: Better Growth
FAI-Bangalore
Ext:
Details of Current or Last Employer
(2)
Company
Name:
Position Held
Address (main office and branch where worked):
Telephone:
& Department
Employment Period: (DD/MM/YY)
Supervisor
Contact Details:
From
Off:
Cell:
Res:
To
Employee Code:
HR Contact Details
& Designation :
Ext:
Off:
Cell:
Res:
Whether employment is of permanent or temporary nature - Permanent Temporary
Agency Details (if temporary or contractual)
Responsibilities:
Remunerations
Page 3 of 5
Reason(s) for Leaving:
FAI-Bangalore
Ext:
Background Verification Form
Please Print Clearly and Provide Complete and Accurate Information
(Criminal, Address and Database)
Personal Details
Full Name
(First, Middle, Last) Lekha
(2) Original passport size colour
photographs
Former Name(s) / Maiden Name (if applicable)
Gender:
Female
Date of Name Change
Permanent Address:
#60 , 4th cross , Govt veternary Hospital Road, Behind Shivalinga Temple , Anjanapura main road ,
Konankunte, Bangalore 62.
Prominent Landmark
Period of Stay at Permanent
Address
From: April/2012
To:Till Date.
Telephone (Home)
Mobile Number
8095898948
Fathers Name
Muralidhar M
Date of Birth (dd/mm/yy)
14/06/89
Passport No
J9297945
Nationality
Indian
Present Address:
Page 4 of 5
FAI-Bangalore
#60 , 4th cross , Govt veternary Hospital Road, Behind Shivalinga Temple , Anjanapura main road ,
Konankunte, Bangalore 62.
Period of Stay at Present
Address
From:
Telephone (Home)
Mobile Number
8095898948
April/2012
To:
Till Date
Prominent Landmark
Letter of Authorization
To whom it may concern
I hereby authorize First American (India) Private Limited and its representative to verify information
provided in my resume and application of employment, and to conduct enquiries as may be necessary,
at the company's discretion. I authorize all persons who may have information relevant to this enquiry
to disclose it to First American (India) Private Limited or its representative. I release all persons from
liability on account of such disclosure.
Signed:
Lekha
Name in Block Capitals: LEKHA HM
Date of Birth:
14/06/89 (dd/mm/yy)
Date:
04/09/14
Page 5 of 5
FAI-Bangalore
