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Background Verification Form

The document is a background verification form that must be completed in full for employment purposes. It requires personal information, educational qualifications, previous employment history, and references, with an emphasis on accuracy and confidentiality. The applicant authorizes the organization to verify the provided information and confirms its correctness.

Uploaded by

Harish Hari
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
9 views3 pages

Background Verification Form

The document is a background verification form that must be completed in full for employment purposes. It requires personal information, educational qualifications, previous employment history, and references, with an emphasis on accuracy and confidentiality. The applicant authorizes the organization to verify the provided information and confirms its correctness.

Uploaded by

Harish Hari
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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BACKGROUND VERIFICATION FORM

 Please note that it is mandatory for you to complete the form in


all respects
 The information you provide must be complete and correct and
the same shall be treated in strict confidence.
 The details on this form will be used for all official requirements when you join the
organization.

Position applied for Branch/Division

Personal Information
Full Name (First, Middle, Last) Date of Birth (DD/MM/YYYY)

Father's Name Mother’s Name

Gender Social Security Number (if applicable) Nationality Marital Status

Current Address Period of From (mm/yy) To (mm/yy) Residence Number


stay

Prominent Landmark Mobile number

Permanent Address Period of From (mm/yy) To (mm/yy) Residence Number


stay

Prominent Landmark Mobile number

Education Qualification (Please mention the details of your Highest qualification)


Name of the Institution & University/Board Dates Attended Qualification Gained ID /Roll No
Address
From To

dd/mm/yy dd/mm/yy Full Time/ Part


Time
Previous Employment History - Please attach a copy of your Relieving cum service letter and last 3 month pay slips

Note: Please ensure that you are descriptive w herever necessary – e.g. If the company has closed, do mention it. Employee
Code/ ID/ Number is mandatory. If your previous employer did not provide one, please mention and state reasons for the same.

Name of Company (1) Address of Company

Telephone No Employee Code/No Designation Department

Employment Period Manager's Name Manager's Contact No


From To
Manager's Email ID

Duties & Responsibilities Reasons for leaving

First Salary drawn W as this Position Agency Details (if temporary or contractual), provide details
Permanent
Temporary
Contractual

Previous Employment History - Please attach a copy of your Relieving cum service letter and last 3 month pay slips
Name of Company (1) Address of Company

Telephone No Employee Code/No Designation Department

Employment Period Manager's Name Manager's Contact No


From To
Manager's Email ID

Duties & Responsibilities Reasons for leaving

First Salary drawn W as this Position Agency Details (if temporary or contractual), provide details
Permanent
Temporary
Contractual
References: Please mention the name and contact details of your colleagues (Previous Organisation)
Reference (1)
Name & Position held:

Email Address:

Contact Number:
How do you know this
person?

Reference (2)

Name & Position held:

Email Address:
Contact Number:

How do you know this person?

(Do not provide name & contact details of your Family members, Relatives or Friends)

Declaration and Authorization

I hereby authorize Genius Consultants and its representatives to verify the information provided in the
background verification form, 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 the authorities of
Genius Consultants. I release all persons from liability on account of such disclosure.

I confirm that the above information is correct to the best of my knowledge. I agree that in the event of my
obtaining employment, my probationary appointment, confirmation as well as continued employment in the
services of the company are subject to clearance of medical test and background verification check done by
the company.

Signature:

Name:

Date:

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