Name : ____________________________________________ Date: _____/_____/_____
Date of Birth : _______/_______/________ Marital Status: Married / Single
Fathers Name:
Address of Communication:
Telephone No:
Permanent Address Current Address
Prominent Landmark Prominent Landmark
Residence Tel # Residence Tel #
Mobile # Mobile #
Period of stay Period of stay
CONFIDENTIAL
Education Qualification Details
Sr. Details Highest Qualification
University name & Location
1 Details
College name & Location
2 Details
Year of passing :
3 (DD/MM/YY)
4 Degree obtained (Yes / No)
5 Seat Number
6 Period : From/To
7 Main Subjects
8 Grade Secured
9 Percentage
CONFIDENTIAL
Employment Details
Sr
. Details Previous Employment 1
Employer Name and full
1 address
2 Office Landline Numbers
Dates Employed :
Joining and Leaving date
3 (DD/MM/YY)
4 Job Title / Designation
5 Gross Salary
Supervisor Name & Contact
6 Number
7 Reason for Leaving
8 Employee Code
CONFIDENTIAL
Employment Details
Sr
. Details Previous Employment (2)
Employer Name and full
1 address
2 Office Landline Numbers
Dates Employed :
Joining and Leaving date
3 (DD/MM/YY)
4 Job Title / Designation
5 Gross Salary
Supervisor Name & Contact
6 Number
7 Reason for Leaving
8 Employee Code
CONFIDENTIAL
Sr
. Details Previous Employment (3)
Employer Name and full
1 address
2 Office Landline Numbers
Dates Employed :
Joining and Leaving date
3 (DD/MM/YY)
4 Job Title / Designation
5 Gross Salary
Supervisor Name & Contact
6 Number
7 Reason for Leaving
8 Employee Code
CONFIDENTIAL
Professional Reference
Sr. Details Professional References (1) Professional References (2)
1 Full Name
Contact
2 Number
Company
he/she is
currently
3 working
Job Title /
4 Designation
CONFIDENTIAL
Letter of Authorization
To whomsoever it may concern
I hereby authorize _____ and its representative to verify information provided in my resume and application of
employment and to conduct enquires 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 _____ and or its representative. I release all persons
from liability on account of such disclosure. In case the organization finds any information contrary to that provided
by me, I accept their decision to withdraw the job offer made to me. The job offer would thereby stand null and void.
Signed: ________________________________
Name in Block Capitals: ________________________________
Date of Birth: ________________________________
Date: _________________________________
Note:
Please attach the following:
1. Photocopy of educational qualification mark sheet and degree certificate.
2. Photocopy of experience/ relieving/ Service certificate of ex-employments.
3. Photocopy of the documents giving proof of the residence along with two recent photographs.
4. A general authority letter will be issued by the employer, which will confirm that SecUR Credentials is
authorized to conduct the background verification checks on behalf of the employer from the
concerned authorities.
CONFIDENTIAL
