BVFBACKGROUND VERIFICATION FORMFILL THIS FORM CLEARLY, CORRECTLY AND IN CAPITALS ONLYPersonal InformationFull Name (expand your surname)Former Name / Maiden Name(Applicable only for married females)Father's NameDate of Birth (DD/MM/YY)GenderSocial Security Number (if applicable)NationalityMarital StatusMalePassport No.Driving License No.FemalePAN Card No.Current AddressPeriod ofFrom (MM/YY) To (MM/YY)Residence Phone Number(Mention Full Address with Pincode & Landmark)stayFull Name:C/o,S/o,D/o:Door No:Street:Mobile numberCity/District:State:Pincode:Prominent LandmarkPermanent Address(Mention Full Address with Pincode & Landmark)Period ofFrom (MM/YY) To (MM/YY)Residence Phone NumberFull Name:stayC/o,S/o,D/o:Door No:Street:City/District:Mobile numberState:Pincode:Prominent LandmarkAddress History (List most recent first) - Mention about all the addresses wherever you stayed in the last 2 YEARSlast two yearsPeriod of StayMention Full Address with LandmarksContact Number(s)From (MM/YY)To (MM/YY)C/o,S/o,D/o:Door No:Street:City/District:State:Pincode:Landmarks:C/o,S/o,D/o:Door No:Street:City/District:State:Pincode:Landmarks:C/o,S/o,D/o:Door No:Street:City/District:State:Pincode:Landmarks:C/o,S/o,D/o:Door No:Street:City/District:State:Pincode:Landmarks:Education Qualification - Mention complete details of SSC & Highest Degree(All Fields are mandatory)Course / Qualification NameCollege Name & AddressDates AttendedUniversity / Board Name & AddressID /Roll NoFromToSSC (10th Class)MM/YYMM/YYFull TimePart TimeHighest Qualification (Mention Degree)MM/YYMM/YYFull TimePart TimeCollege Contact Person: Name& Designation:landline Num:Official Email ID:Please tick mark the documents submitted for this qualification along with this formMarksheetProvisional CertificateDegree CertificateNoneEmployment History (All fields are Mandatory)Note: Give descriptive information where ever necessary e.g. If the current/previous company is closed, do mention it under "Reasons for Leaving". Employee Code/ ID is mandatory. Incase you dont have an EMP ID/No., mention the same under respective field.Current Employer - Please attach a copy of your Offer letter, Pay Slips, Increment lettersName of Current Employer(Company Name)Address of Current EmployerBoard No./HR Dept No.Employee Code/IDDesignationDepartmentEmployment PeriodManager's NameManager's Contact NoCan the check be done now?FromToManager's Email IDYesNoDuties & ResponsibilitiesReasons for leavingFirst Salary (Gross Per Month)Is this PositionAgency Details (if temporary or contractual), provide detailsPermanentLast Salary (Gross Per Month)TemporaryContractualPlease tick mark the documents submitted for this employmentOffer LetterExperience LetterRelieving LetterPay SlipsNonePrevious Employer 1 - Please attach a copy of your relieving letter or experience letterName of Previous Employer (1)(Company Name)Address of EmployerBoard No./HR Dept No.Employee Code/IDDesignationDepartmentEmployment PeriodManager's NameManager's Contact NoFromToManager's Email IDDuties & ResponsibilitiesReasons for leavingFirst Salary (Gross Per Month)Was this PositionAgency Details (if temporary or contractual), provide detailsPermanentLast Salary (Gross Per Month)TemporaryContractualPlease tick mark the documents submitted for this employmentOffer LetterExperience LetterRelieving LetterPay SlipsNonePrevious Employer 2 - Please attach a copy of your relieving letter or experience letterName of Previous Employer (2)(Company Name)Address of EmployerBoard No./HR Dept No.Employee Code/IDDesignationDepartmentEmployment PeriodManager's NameManager's Contact NoFromToManager's Email IDDuties & ResponsibilitiesReasons for leavingFirst Salary (Gross Per Month)Was this PositionAgency Details (if temporary or contractual), provide detailsPermanentLast Salary (Gross Per Month)TemporaryContractualPlease tick mark the documents submitted for this employmentOffer LetterExperience LetterRelieving LetterPay SlipsNoneReference Details: Provide details of both professional and personal referencesProfessional Reference: To be filled if you are currently working or experiencedName, Company & Designation:Current Address:Contact No:How do you know this person?Personal Reference: Mention about any one of your friends or family membersName & Occupation:Current Address:Contact No:How do you know this person?Please mention about GAPS during Education and Employment - MANDATORY (If there were NO GAPS, just leave it blank)From (MM/YY)To (MM/YY)Reason for Gap:Complete Address and Location during gap:From (MM/YY)To (MM/YY)Reason for Gap:Complete Address and Location during gap:From (MM/YY)To (MM/YY)Reason for Gap:Complete Address and Location during gap:Declaration and AuthorizationI hereby authorize Pvt. Ltd.(or a third party agent appointed by the Company) to contact any former employers as indicated above and carry out all Background Checks not restricted to education and employment deemed appropriate through this selection procedure. I authorize former employers, agencies, educational institutes etc. to release any information pertaining to my employment/education and I release them from any liability in doing so.I confirm that the above information is correct to the best of my knowledge and I understand that any misrepresentation of information on this application form may, in the event of my obtaining employment, result in action based on company policy.Signature:Full Name:Date: