Note: Please don’t take print, to be typed only.

All the details are mandatory and mention “Not applicable” wherever is
required

BACKGROUND VERIFICATION FORM

Personal Details

Full Name: Male /Female Marital Status: Single/ Married

Date of Birth: Nationality: Father’s name:

Employee No: Designation:

Place of joining: Date of Joining:

Current Address: (Attach Proof)

Period of stay at current address: From: To:

Telephone (Home): Mobile:

Email address:
Permanent Address: (Attach Proof)

Period of stay at current address: From: To:

Telephone (Home): Mobile:

Address History: Furnish addresses of your residence in the last ten (10) years (Attach additional sheet if you have more
than 6 residential addresses in the last 10 years)

Period of stay Address State Country Zip Code

From To
 Educational qualification: (Highest Degree)

(Important: Copy of Mark sheet and Degree certificate MUST be attached)

College name

College Address

University Name and address

From – To
Graduated Program Student ID/ Enrolment No
(Month / Year)

Full time /Part

Yes / No
time/ Day / evening

Type of degree Graduation date Major Subject

Please account for any and all gaps in education or employment during your tenure

Education

From To Reason:

Experience

From To Reason:

Employment Details – Furnish all the details of your employment history for last 5 years please attach additional
sheets if required (Appointment letter and relieving letter for all the previous employments and accepted
resignation letter copy of current employer must. Any other documents that support employment with the
organization)

1
Details of Current / Immediate last employment

Position Held&
Company Name:
Dept.

Address of the Head

Telephone no(s)
office
of Head office

Address of the
office in which
worked (if different Telephone no(s)
from the head of Branch office
office)

Employment date: ( Date, Month , Year)

Employee code:
From: To:

Whether employment is temporary or permanent in Nature -

Agency details ( If temporary or Contractual)

Responsibilities:

Last drawn CTC P.A: Reason for leaving:

Do you grant permission for checks to be undertaken with this employer now: YES / NO
If no, when can the checks be undertaken? (may not exceed your 1st day at SMG)

Reported to
Functional reporting Operational reporting
Name of the reporting authority

Position of the reporting authority

Landline No

Mobile no

Email Id

2
Details Employment – 2 Last

Position Held&
Company Name:
Dept.

Address of the Head

Telephone no(s)
office
of Head office

Address of the
office in which
worked (if different Telephone no(s)
from the head of Branch office
office)

Employment date: ( Date, Month , Year)

Employee code:
From: To:

Whether employment is temporary or permanent in Nature -

Agency details ( If temporary or Contractual)

Responsibilities:

Last drawn CTC P.A: Reason for leaving:

Do you grant permission for checks to be undertaken with this employer now: YES / NO
If no, when can the checks be undertaken? (may not exceed your 1st day at SMG)

Reported to
Functional reporting Operational reporting
Name of the reporting authority

Position of the reporting authority

Landline No

Mobile no

Email Id

3
Details Employment – 3 Last

Position Held&
Company Name:
Dept.

Address of the Head

Telephone no(s)
office
of Head office

Address of the
office in which
worked (if different Telephone no(s)
from the head of Branch office
office)

Employment date: ( Date, Month , Year)

Employee code:
From: To:

Whether employment is temporary or permanent in Nature -

Agency details ( If temporary or Contractual)

Responsibilities:

Last drawn CTC P.A: Reason for leaving:

Do you grant permission for checks to be undertaken with this employer now: YES / NO
If no, when can the checks be undertaken? (may not exceed your 1st day at SMG)

Reported to
Functional reporting Operational reporting
Name of the reporting authority

Position of the reporting authority

Landline No

Mobile no

Email Id

4
 Reference Details: Please provide details of two professional references

Details Reference 1 Reference 2

Reference Name

Title & Designation

Is the above mentioned Reference

from the current Company

Full Address (with Company Name)

Contact Details of the referee :

Landline No with country / STD code

Mobile No

Email ID

Period for which the referee knows the

candidate

Recent Passport size photograph

Date: Place: Signature: ( Digital)

5
 Letter of Authorization:

To whomsoever it may concern

I hereby authorize Suzuki Motor Gujarat Private Limited and its authorized representatives 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 Suzuki Motor Gujarat Private
Limited or its representative. I release all persons from liability on account of such disclosure.

I hereby authorize concerned authorities to dispatch my confidential report to Suzuki Motor

Gujarat Private Limited or its authorized representative.

Signed: ---------------------------------------------------

Name: ------------------------------------------------------

Date: -----------------------------------------------------------

** As is the procedure followed by most police departments across India for criminal back
ground verification, it is possible that police authorities may contact or visit the stated
residence and at times even ask to be physically present at the concerned police station. It is
part of the standard verification procedure.

Document Required along with the background verification form

6
 (Failure to attach the relevant documents will delay th BGV process)

1. Your Recent Passport size photograph pasted at the appropriate place

2. Self-attested & signed copy of Identity proof

a. Valid passport / Driving license / PAN card / Voter’s ID card

3. Copies of address proof, either of the following:

a. Ration card
b. Electricity bill
c. Land line Telephone bills
d. House lease agreement

4. Copies of Degree certificates, transcripts, mark sheets, enrollment number, etc. as required by your university.
(Highest Completed Degree Level Education only)

5. Documents supporting your employment for all previous employments :

a. Appointment letter (must)
b. Relieving letter (must). For the current organization where you are working : accepted copy of
resignation letter
c. Full and final settlement
d. Pay slip- Last 3 months
e. Experience certificate if given by your previous employers