Candidate Declaration Form (CDF) – Calpion Software Technologies

Pvt.Ltd.
Instructions: Please provide all the information requested in this form. Incomplete Candidate Declaration Forms
(CDFs) will be returned. All supporting documents must accompany this form. Photocopies must be legible. We
have included a checklist to assist you to complete your application comprehensively.

PERSONAL DETAILS
Full Name (First/Middle/Last): venkadesh G

Fathers Name: _Gopalakrishnan M_________________________________________________________________________

Date of birth (DD/MM/YY): 07/11/1997 Mobile Number:_8590797223___Nationality: _Indian____________

Passport Number: ______No____________Date of issue: ___________________Date of expiry: _______________

Social Security Number (If worked/studied in the US/Any other Country) ___________________________________

Blood Group: A positive Emergency Contact number: 8883946641 Landline no:

Physically challenged: Yes/No If yes please mention the details;

Change of Name if Applicable

Former Name/Maiden Name _____________________________ ________________________________

Date of Name Change ___________________________

Current Address (Complete Postal Address Including the Door No, Street name, Locality, City, Pin code & State)

600/163 B anna colony kovil street tiruchendur 628215

______________________________________________________________________________________________

______________________________________________________________________________________________

Land Mark: Hotel mani Iyer Period of Stay: From 07/11/1997 To

Present

Permanent Address

600/163 b anna colony kovil street tiruchendur -

628215______________________________________________________________________________________________

______________________________________________________________________________________________

Land Mark: Hotel Mani Iyer Period of Stay: From 07/11/1997 To

present

1
EDUCATION DETAILS

Highest Graduation
Name of the Institute/College
Kings Engineering College
Student ID No: / Enrolment No Duration of Study Four years
210815114050
Division / Class/ % Degree Obtained Yes
B.E (MECH )
Subject Major MECHANICAL Course Type regular
(Regular/Distance
Name of University Anna university

Name of College/Study Centre Kings engineering college

Address of Institution
City: chennai State:
tamilnadu
Pin: (Landline)

*: (Email ID)

Note: Please attach legible Xerox copies of the following documents relevant to the entries above
1) Mark sheets of all semesters/years 2) Degree Certificates, FRONT and BACK 3) Provisional Certificates

PREVIOUS EMPLOYMENT DETAILS (Company 1)

Name of Company Infinix Healthacre

Where were you  Registered Corporate  Branch Office

employed? Office
Type of Employment  Permanent  Contractual
Company Address Door No/Street

(Where you were City chennai State tamilnadu

employed )
Pin  (Landline)
600040

Period of employment April 3 2019 Employee Code 47302

(DD/MM/YYYY)
Designation ar caller Last Drawn Salary (CTC) 21000

Skills worked in present no

org
Department : ar caller Reported to: Sathish manager

Supervisor’s Name & kumar Supervisor’s

Designation Direct Number [email protected]
&  (Email Id)

HR Name & Designation Jeeviya Email Id [email protected]

State you Reason for Health issue
leaving

2
Can a reference be taken
 Yes  No
now?
If No, when can it be taken?

Note: Please attach legible Xerox copies of the following documents relevant to the entries above
1) Appointment Letter 2) Salary Slip 3) Release Letter

PREVIOUS EMPLOYMENT DETAILS (Company 2)

Name of Company Sutherland healthcare solutions

Where were you  Registered Corporate  Branch Office

employed? Office
Type of Employment  Permanent  Contractual
Company Address Door No/Street A1 ,6th floor No 16 GST Road , perungalathur Chennai-600063

(Where you were City chennai State Tamilnadu

employed )
Pin 600063  (Landline)
Period of employment March 2022 Employee Code 532086
(DD/MM/YYYY)
Designation Senior Ar caller Last Drawn Salary (CTC) 41000

Skillset worked in this no

org :
Department : medicql billing Reported to: vijay

Supervisor’s Name & Vijay (manager) Supervisor’s 7299876120 ( vijay.k

Designation Direct Number @sutherlandglobal.com)
&  (Email Id)

HR Name sathya Email ID [email protected]

State you Reason for Family issue
leaving
Can a reference be taken
 Yes  No
now?
If No, when can it be taken?

Note: Please attach legible Xerox copies of the following documents relevant to the entries above
1) Appointment Letter 2) Salary Slip 3) Experience or Release Letter

Authorization/ Declaration and Undertaking

I hereby authorize Calpion Software Technologies Pvt ltd. to verify my background credentials from IBC Verification
Services Pvt. Ltd. (IBC). I understand that employment with Calpion Inc is governed by their employment policies as applicable,
including satisfactory information from background checks.

I hereby certify that all information provided herein, is true and complete to the best of my knowledge and belief. I authorize
Calpion Software Technologies Pvt ltd. and its representative IBC to authenticate information I have provided in my
resume and this Candidate Declaration Form (CDF). To conduct enquiries as may be necessary at the company’s discretion, I
authorize all who may have information relevant to this enquiry to disclose it to IBC and/or its representatives. I release all
concerned from any liability on account of such disclosures.

I promise to extend total co-operation and provide relevant documents required.

Full Name of the Candidate: _____venkadesh .G Signature of the Candidate

Venkadesh G
3
Place: ___coimabtore_________________________________________________

Date: _____________________________________________________

Checklist for Candidates Just Tick

Note: This checklist is to assist you. Please go through all the columns.
Personal Details

Fathers’ Name Yes No

Your Date of Birth Yes No
Your Passport Details Yes NA
Mobile number Yes No NA
SSN/Other Country Nos. Yes No NA
Personal Contact  No. Yes No NA
Date of Name Change Yes No NA

Education
Graduation Post Graduation
Student Id/Enrolment No. Yes No NA Yes No NA
School/College Name Yes No NA Yes No NA
Location Yes No NA Yes No NA
University/ Institution Name Yes No NA Yes No NA
Mark sheets Yes No NA Yes No NA
Provisional Certificates Yes No NA Yes No NA
Degree Certificates Yes No NA Yes No NA
Yes No NA Yes No NA
Employment
Emp 1 Emp – 2
Name of Company Yes No NA Yes No NA
Location Yes No NA Yes No NA
Company Contact Nos. Yes No NA Yes No NA
Employee Code Yes No NA Yes No NA
Period of Employment Yes No NA Yes No NA
Appointment Letter Yes No NA Yes No NA
Relieving Letter Yes No NA Yes No NA
Accurate Remuneration Yes No NA Yes No NA
Person Reporting to/Name/No Yes No NA Yes No NA