Birlasoft ID :

Normal Priority Senior Profile

BACKGROUND CHECK INITIATION / EMPLOYMENT APPLICATION FORM

PERSONAL DETAILS

First Name (as per

proof attached)

Middle Name Please attach recent

passport size
photograph
Last Name /
Surname

Date of Birth Nationality

(DD/MM/YYYY)
Former / Maiden Name (s) /
(if Applicable):
Father’s / Husband’s Name
(mandatory for India):
City and
PAN No./ Social Country of
Security No. Birth

Marital Status: Married / Single / Separated / Widowed (please Gender:  Male  Female  Others
tick - mandatory information for India) (mandatory information for India)
Mobile Number Home
(s) Number:
(with STD
Code)
Contact e-mail ID:

Place & Date of Issue

Passport Country
Number of Issue Date of
Expiry
Has your visa ever been rejected?: (If Yes, please complete the following:)

When: For which country: Reason:

Version: 3.0 -1-

Birlasoft Classification: Public
 Type of Address Complete Address (No abbreviations) Stay From : (MM/YY) Telephone & Mobile
Stay Till: (MM/YY) Number with Local Code
1) Permanent Address STD Code :
(No abbreviations) Landline #

Mobile #:
Prominent Landmark
(Mandatory)
Best suitable time to contact Contact number of person
available at home (with code)
2) Current Address STD Code :
(No abbreviations) Landline #

Mobile #:

Prominent Landmark
(Mandatory)
Best suitable time to contact Contact number of person
avalable at home (with code)
Previous Address (if duration STD Code :
of stay in current address is #
less than one year) Mobile:
#

Part II : Please fill up three professional reference details. Please inform them that they will be contacted by our
background verification agencies
Reference 1 Reference 2 Reference 3

(From your Current Employer ONLY) (From your Current Employer ONLY) (From your Past Employer ONLY)

Name

Designation

Organization

Relationship

Address

Mobile
Number
Landline
Number with
extension
Best time to
contact

Version: 3.0 -2-

Birlasoft Classification: Public
 PART-III. Please fill in the following details regarding your work experience. Start with your current job and end with
your first job. Please mention reasons for breaks in career if any. Employee ID is to be mandatorily mentioned

Employer means the one who is your primary employer, on whose you are and who pays your salary / fees.

CURRENT EMPLOYMENT RECORDS (EMPLOYMENT PRIOR TO BIRLASOFT)

CURRENT EMPLOYER: Employee ID From (MM/YY): To (MM/YY):
(mandatory):

Street Address: LAST DRAWN CTC: Employer’s Office Fax No.:

Phone No.:

City: State: Country: Postal Code:

Last held Job Title: Reason for Leaving:

Employment Status: (Please check the relevant box) Supervisor’s Details:

Full Time
Contract /Through Outsourcing Agency Name:

Details of Your Principal Employer (if different from Title:

primary employer):
Office Phone No. &
(principal Employer is the one where you were placed at)

Name: Mobile
E-mail id of supervisor:
Address: (Official)

HR Manager’s Details:

Tel No.:
Name:

Best time to contact your Supervisor: Office Phone No. &

Mobile
E-mail id:
(Official)
Any Other Information you wish to share about your current employment:

Break, if any, in your employment: If yes, please mention the period of break and reason:
___________________________________________________________________________________
___________________________________________________________________________________

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Birlasoft Classification: Public
 PREVIOUS EMPLOYMENT RECORDS
EMPLOYER 1: Employee ID From (MM/YY): To (MM/YY):
(mandatory):

Street Address: LAST DRAWN CTC: Employer’s Office Fax No.:

Phone No.:

City: State: Country: Postal Code:

Last held Job Title: Reason for Leaving:

Employment Status: (Please check the relevant box) Supervisor’s Details:

Full Time
Contract /Through Outsourcing Agency Name:

Details of Your Principal Employer (if different from Title:

primary employer):
Office Phone No. &
(principal Employer is the one where you were placed at)

Name: Mobile
E-mail id of supervisor:
Address: (Official)

HR Manager’s Details:

Tel No.:
Name:

Best time to contact your Supervisor: Office Phone No. &

Mobile
E-mail id:
(Official)
Any Other Information you wish to share about your employment:

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Birlasoft Classification: Public
 PREVIOUS EMPLOYMENT RECORDS
EMPLOYER 2: Employee ID From (MM/YY): To (MM/YY):
(mandatory):

Street Address: LAST DRAWN CTC: Employer’s Office Fax No.:

Phone No.:

City: State: Country: Postal Code:

Last held Job Title: Reason for Leaving:

Employment Status: (Please check the relevant box) Supervisor’s Details:

Full Time
Contract /Through Outsourcing Agency Name:

Details of Your Principal Employer (if different from Title:

primary employer):
Office Phone No. &
(principal Employer is the one where you were placed at)

Name: Mobile
E-mail id of supervisor:
Address: (Official)

HR Manager’s Details:

Tel No.:
Name:

Best time to contact your Supervisor: Office Phone No. &

Mobile
E-mail id:
(Official)
Any Other Information you wish to share about your employment:

Version: 3.0 -5-

Birlasoft Classification: Public
 PREVIOUS EMPLOYMENT RECORDS
EMPLOYER 3: Employee ID From (MM/YY): To (MM/YY):
(mandatory):

Street Address: LAST DRAWN CTC: Employer’s Office Fax No.:

Phone No.:

City: State: Country: Postal Code:

Last held Job Title: Reason for Leaving:

Employment Status: (Please check the relevant box) Supervisor’s Details:

Full Time
Contract /Through Outsourcing Agency Name:

Details of Your Principal Employer (if different from Title:

primary employer):
Office Phone No. &
(principal Employer is the one where you were placed at)

Name: Mobile
E-mail id of supervisor:
Address: (Official)

HR Manager’s Details:

Tel No.:
Name:

Best time to contact your Supervisor: Office Phone No. &

Mobile
E-mail id:
(Official)
Any Other Information you wish to share about your employment:

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Birlasoft Classification: Public
 III. Please provide details regarding your academic qualifications:

Name & Period Course

Enrollment No &
Institution Address of dd/mm/yy Attended
Area of Roll No / Please
(School/ University Certificate (Morning/
Specialisation % Marks/ mention whether
College/Instit To which Year of / Degree/ Evening/
/ Major CGPA you have
ute) and College / Enrolment – Diploma Corresponde
Year of Subjects graduated – Yes
Address Institute nce)
is affiliated to Passing or No

Post Graduate
Degree(s)

Bachelor
Degree (s)

HSC/ Pre
university

SSC/ 1th
equivalent

Other(s)

Please provide details regarding your skills training/ certification

Skills Training received Certification Available

(Y/N)





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Birlasoft Classification: Public
IV. Please answer the following in the space provided below

Are you currently under service agreement with your existing employer? (Y / N)

What is the notice period with your current employer? Days/ Months

What is your expectation in terms of compensation per annum? Rs. per annum

Are you willing to travel/ relocate as may be required by the organization? (Y / N)

Have you suffered from any major health problem(s), which required you to be away from work for more than 15 days, in the past 5 years?
If yes, please give details.

Major social, leisure and sporting activities and achievements, including positions of responsibility held, if any:

Any additional information that you would like to provide that could be relevant to your application.

Do you know any current employees at Birlasoft? If yes, please provide their names below with their respective function and designation
and your relationship with them:

Do you have any relatives working for Birlasoft ? If yes, please mention the following:

Name of employee: Relationship::

Department: Designation:

Have you every previously applied to Birlasoft? (Yes / No)

If yes, position applied for and date/month of interview:

If employed by Birlasoft, I agree to provide copies of mark sheets and relevant certificates. I understand that employment with Birlasoft
is contingent upon several factors, including satisfactory information from a reference check

All representations made by me in this data sheet are true and correct to the best of my knowledge and belief, and I have not
knowingly omitted any related information of an adverse nature. Inaccurate information may make me ineligible for employment.

____________________________
Applicant’s Signature & Date

Version: 3.0 -8-

Birlasoft Classification: Public
 Letter of Authorization
To whom it may concern

I understand that Birlasoft may use an outside agency to verify and validate the information I have provided
including my employment, my personal background, professional standing, work history and qualifications.

I understand that an outside background agency may obtain information it deems appropriate from various
sources including, but not limited to, the following: current and past employers, criminal conviction / ongoing
criminal case records, School & College records, Identity Records and professional and personal references.

I authorize, without reservation, any individual, corporation or other private or public entity to furnish
Birlasoft and the outside background agency all information about me.

I unconditionally release and hold harmless any individual, corporation, or private or public entity from any
and all causes of action that might arise from furnishing to Birlasoft and the outside agency information that
they may request pursuant to this release.

This authorization and release, in original, faxed or photocopied form, shall be valid for this and any future
reports and updates that may be requested.

Signed: __________________________________________________

Name in Block Capitals: __________________________________________________

Date of Birth: __________________________________________________ (dd/mm/yyyy)

Date: ________________________

Version: 3.0 -9-

Birlasoft Classification: Public