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Candidate AC Form - Anti Corruption Form Page 1

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R C Ambernath Smartcity
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39 views1 page

Candidate AC Form - Anti Corruption Form Page 1

Uploaded by

R C Ambernath Smartcity
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Anti-Corruption Screening Form

(to be completed by in-scope applicants as defined in the Anti-Corruption HR Screening Plan, v2.2020)
Notice to Applicants: The information collected herein is part of the application process, is being collected to
determine if you have any conflicts of interest that may present a corruption risk or an appearance of
improper influence for the position that you are applying for, and the Company reserves the right to ask for
additional information beyond what is asked in this application. Furthermore, by completing this application,
the applicant agrees that if subsequent developments cause the information reported herein to be no longer
accurate or complete, the applicant will immediately notify the Company regarding a change in
circumstances. By providing this information, the applicant certifies that the statements and information
contained in this submittal are true, accurate, and complete. Any misrepresentation or concealment of
information may result in the employment termination in accordance with market-specific policies.

The information collected on this form is used for recruiting and employment purposes.

1. Have you been employed by a Government Entity within the last two years, or are you
currently employed by a Government Entity, or do you anticipate holding a government
position/title within the next 12 months?
A Government Entity is any government department, agency, ministry, instrumentality, or entity, whether
federal, central, state, or municipal, including the administrative, judicial, and legislative bodies; any political
party or political campaign; any public sector undertaking, or state-owned or state-controlled department,
company, corporation, partnership, enterprise, public institution, or civil association; any public international
organization; any any panchayat, recognized traditional or tribal council, governing body, or authority, or any
recognized traditional or royal family. In the case of political party candidacy or position, please state the office
for which you are running or hold/held (ex. mayor), but do not identify the political party affiliation.
Examples of Government Entities include but are not limited to:
• Government departmnets: Police Departnmets (State/Local), Excise Department (Central/State);
• Central/State Government Ministries: Ministry of External Affairs, Ministry of Finance
• Government Agencies: Indian Army, Reserve Bank of India, SEBI
• Public Sector Undertakings: State Bank of India, General Insurance Corporation of India Limited
• Central and State Government schools/colleges/universities: IITs, IIMs
• Public International Organizations: United Nations, IMF, World Bank

YES NO
If “YES”, provide the information regarding past/current/future government employment below
(attach list on a separate page, as needed):

For Past Government Positions (Last Two Years)

Please identify the Government Entity that employed you: ____________________________

Please identify the position/title you held: ___________________________________________

Please identify the dates that you were employed: ____________________________________

Please identify the city where the Government Entity is located: __________________________

For Current Government Positions


Please identify the Government Entity that employs you: ______________________________

Please identify the position/title you hold: ___________________________________________

Please identify the city where the Government Entity is located: __________________________

For Future Government Positions (Future 12 Months) mark “N/A” if future employment is not known
Please identify the Government Entity that you anticipate holding a position/title with

Page 1 of 2 v2.5.20, updated 01.18.22

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