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Background Screening Affidavit Template

This document certifies that background screening was completed for personnel deployed under a requisition with Pontoon Solutions. The screening results for personnel in the "Green" category produced no adverse information to disqualify them from performing services. The supplier complied with federal, state, and local laws regarding employment eligibility verification and non-discrimination. It also certifies the supplier will only refer lawfully authorized workers and provides details of the background check process such as the vendor used and drug test details where required.

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ANKIT SINGH
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185 views2 pages

Background Screening Affidavit Template

This document certifies that background screening was completed for personnel deployed under a requisition with Pontoon Solutions. The screening results for personnel in the "Green" category produced no adverse information to disqualify them from performing services. The supplier complied with federal, state, and local laws regarding employment eligibility verification and non-discrimination. It also certifies the supplier will only refer lawfully authorized workers and provides details of the background check process such as the vendor used and drug test details where required.

Uploaded by

ANKIT SINGH
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd

SCHEDULE 1 to EXHIBITB

AFFIDAVIT
Date: _____________
To whom it may concern at Pontoon Solutions:

This is to certify that the background screening verification of Personnel pursuant to the
**Requisition ID __ (“Requisition”) issued under the Subcontracting Agreement with Pontoon
Solutions, Inc. (“Pontoon”) dated __ (“Agreement”), has been completed for Personnel deployed
pursuant to Requisitions and specified hereunder.

Approved Supplier (as identified below) further certifies that the background screening results
for Personnel under the category “Green” have produced no adverse information with regard to
the background screening requirements sufficient to disqualify such employee or Personnel
from performing Services pursuant to a Requisition. In conducting the background screening,
Approved Supplier has complied with the requirements specified in the Agreement and/or
otherwise.

In addition, this letter also certifies that Approved Supplier has complied with all federal, state,
and municipal laws and regulations relating to the performance of its duties hereunder including,
but not limited to, the provisions of the Immigration Reform and Control Act of 1986, including
the provisions that (1) prohibit hiring and continued employment of unauthorized persons, (2)
require verification and recordkeeping with respect to identity and eligibility for employment, and
(3) prohibit unlawful discrimination under applicable law. Approved Supplier will provide Pontoon
their e-verify number and date of filing to confirm their capability of compliance with employment
eligibility of all their Personnel.

By executing this attestation Approved Supplier certifies that the resource deployed, or who will
be deployed under this attestation and assignment is lawfully authorized to work in the U.S., and
that Approved Supplier complies with I-9 form requirements to verify that persons employed or
otherwise engaged by Approved Supplier are lawfully eligible to work in the U.S.
 
Approved Supplier further certifies that it will not refer to Infosys any resources unless said
persons are lawfully authorized to work in the U.S.

Personnel Date Location Status of Final Outcome Final Remarks


Name * of (City)* Background (Red/Yellow/Green) Closure (For
Joining Screening * * Date * Yellow/Red)

** All fields marked with an asterisk are mandatory


The above background checks have been conducted through an external background
verification agency.

* Name of Background check vendor:


* BGC order number #
* Drug Test completion date/ panel type: (N/A if DT was not a requirement)
* Did the candidate complete the drug screen with favorable results? Y/N
* eVerify Number & Date of Filing:

Approved Supplier Name: _____________________________________________________

Signature of Authorized Signatory: ______________________________________________

Name of Authorized Signatory: _________________________________________________

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