BACKGROUND CHECK FORM - Project Specific BGC

TCS Employee /BA ID: Project Name: Location:

Designation: Date of joining:

Name of the Associate / BA (Full name expanding initials):

Contact Landline Phone no.: Mobile Phone no. email id:

Father’s Name:

Date of birth (Attach Proof): Marital Status: Nationality:

A. Present Residential Address : (Attach Proof)

Period of Stay From : To:Till date Landmark:

City/Town: State: Pin code:

B. Other Residential Address: [Furnish other addresses of your residence in the last seven (7) years]
Other Residential Address 1: Other Residential Address 2: Other Residential Address 3:
From : To: From : To: From : To:
None None None

City/Town: City/Town: City/Town:

State: State: State:
Pin code: Pin code: Pin code:
Landmark: Landmark: Landmark:
Attach Additional Sheet, if you have stayed in more than 3 Other Residential addresses (locations)
C. Permanent Address: (Attach Proof)
Period of Stay From : To: Till Date Landmark:

City/Town: State: Pin code:

Contact Landline Phone no.: Mobile Phone no.:

A) Is any case pending against you in any court of Law at the time of filling up this Background Check Form?

B) Is any case pending against you in any University or any other educational authority / institution at the
time of filling up this Background Check Form ?

C) If the answer to any of the above mentioned questions is ‘ Yes’ give full particulars of the case /arrest / detention

TCS Confidential Background Check Form – Project Specific BGC Version 1.0 Page 1 of 7
/ fine / conviction / sentence / punishment etc. and / or the nature of the case pending in the Court / University /
Educational Authority etc., at the time of filling up this form.(Attach additional sheet, if required)

Reference Details:
Details Reference 1 Reference 2
Reference Name (No Relatives/Friends
to be given as Reference)
Title & Designation:
(Supervisor/Person holding responsible
Position in a Reputed Organization.):
Is the above mentioned Reference/
Supervisor from the current Company Yes / No Yes / No
Full Address (with Company Name):

Contact details Official email ID:

Landline Telephone No.:

Mobile Phone No.:

Period for which the Reference knows the

Applicant (Minimum 2 years)
Relationship with the Applicant
(No Relatives/Friends)
Passport Details (Attach Proof):

(i) Name as in Passport:

(ii) Passport No : (iii) Place of Issue :

(iv) Date of Issue : (v) Date of Expiry :

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Educational Qualifications (Attach Proof)
Name as in Certificate: __________________________________________________________________________

Qualification Highest Degree Qualification prior to Highest Degree

Mode of Education
(Full time/Correspondence/Partime): Full time
Name of Examination Passed (B.E./M.Tech, etc.):

Specialization / Main Subjects:

Name of Institute / College /

University:

Address:
(Give Complete Address)

Institute / City/Town: City/Town:

College /
University State: State:
Details Pin code: Pin code:
Landmark: Landmark:
Office Landline Ph No.:
Name of Affiliated University:
Affiliated University
Location:
Date From:
Period of Study Date To:
Seat No. / Roll No./ Regn No.:
Year of Passing:
% of marks & Class / Grade obtained:

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Employment Details (Starting from your Current/Immediate Last Employment) (Attach Proof):
Previous Employer’s Description Current / Immediate Last Employment Previous Employment 1
Period Date of emp. From:
Date of emp. To:
Employee Designation:
Details Employee #:
HR HR Name:
Details HR Designation:
Office Landline Ph No.: Do not provide Mobile Ph No Do not provide Mobile Ph No
Email:
Supervisor Supervisor Name:
Details Supervisor Designation:
Office Landline Ph No.: Do not provide Mobile Ph No Do not provide Mobile Ph No
Email:
Last drawn CTC:
Reasons for leaving:
Employer Employer Name:
Details
Address:
(Give Complete
Address incl. Postal
code, prominent
landmark)
Town/City: Town/City:
State: Pin Code: State: Pin Code:
Office Landline Ph No.: Do not provide Mobile Ph No Do not provide Mobile Ph No
Company Status: Is company currently functioning? Yes / No Is company currently functioning? Yes / No

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 Previous Employer’s Description Previous Employment 2 Previous Employment 3
Period of Date of emp. From:
employment Date of emp. To:
Employee Designation:
Details Employee #:
HR Details HR Name:
HR Designation:
Office Landline Ph No.: Do not provide Mobile Ph No Do not provide Mobile Ph No
Email:
Supervisor Supervisor Name:
Details Supervisor Designation:
Office Landline Ph No.: Do not provide Mobile Ph No Do not provide Mobile Ph No
Email:
Last drawn CTC:
Reasons for leaving:
Employer Employer Name:
Details
Address:
(Give Complete Address
incl. Postal code,
prominent landmark)

Town/City: Town/City:
State: Pin Code: State: Pin Code:
Office Landline Ph No.: Do not provide Mobile Ph No Do not provide Mobile Ph No
Company Status: Is company currently functioning? Yes / No Is company currently functioning? Yes / No

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 Previous Employer’s Description Previous Employment 4 Previous Employment 5
Period of Date of emp. From:
employment Date of emp. To:
Employee Designation:
Details Employee #:
HR Details HR Name:
HR Designation:
Office Landline Ph No.: Do not provide Mobile Ph No Do not provide Mobile Ph No
Email:
Supervisor Supervisor Name:
Details Supervisor Designation:
Office Landline Ph No.: Do not provide Mobile Ph No Do not provide Mobile Ph No
Email:
Last drawn CTC:
Reasons for leaving:
Employer Employer Name:
Details
Address:
(Give Complete Address
incl. Postal code,
prominent landmark)

Town/City: Town/City:
State: Pin Code: State: Pin Code:
Office Landline Ph No.: Do not provide Mobile Ph No Do not provide Mobile Ph No
Company Status: Is company currently functioning? Yes / No Is company currently functioning? Yes / No
Note: (i) You may attach additional sheets, if required, to provide more details on your Previous Employments

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Gaps during Education/Employment (Attach Proof):
From To Reasons for gap
- -
Gap Period
1

- -
Gap Period
2

Declaration and General Consent to Background Investigation

To be signed by Associate / Business Associate

In connection with rendering services to Tata Consultancy Services Ltd. (the "Company"), as an Associate /
Business Associate (BA)

I hereby agree as follows:

I certify that the information furnished in this form as well as in all other forms filled-in by me in conjunction
with my rendering of services as an Associate / BA is factually correct and subject to verification by TCS
including Reference Check and Background Verification.

I accept that my services as Associate / BA can be revoked and/ or terminated without any notice at any time
in future if any information has been found to be false, misleading, deliberately omitted/ suppressed.

As a condition of Company's consideration of my rendering of services as an Associate / BA to the

Company, I hereby give my consent to the Company to investigate or cause to be investigated through any
third parties my personal, educational and pre or post-employment history, criminal history and any other
checks, including Drug test as required for complying with TCS and or Client specific BGC requirements. I
understand that the background investigation will include, but not be limited to, verification of all information
given by me to the Company. I confirm that the Company is entitled to share such investigation report with
its clients to the extent necessary in connection with the Services, which I may be required to provide to such
clients. I confirm and undertake that the Company shall incur no liability or obligation of any nature
whatsoever resulting from such investigation or sharing of the investigation results as above.

I certify that I am at present in sound mental and physical condition to undertake my rendering of services as
an Associate / BA with TCS. I also declare that there is no criminal case filed against me or pending against
me in any Court of law in India or abroad and no restrictions are placed on my travelling anywhere in India or
abroad for the purpose of business of the company.

I Agree: Yes

Name TCS Emp / BA ID:

Place Date:

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