Background Declaration Form
Please print and complete all information. All fields including signature are mandatory.
Note: Please avoid using short forms / abbreviations where ever possible.
Personal Details
Full Name First Name Middle Last Name/Surname
SUNDARAMOORTHY. M SUNARAMOORTHY M
Have you ever changed your name? ✔ No Yes (Please attach a copy of the name change
document)
If Yes, name change date: DD/MON/YYYY
Previous Name(s) / First Name Middle Last Name/Surname
Maiden Name (if
applicable)
Father’s Name First Name Middle Last Name/Surname
MUNIRAJ MUNIRAJ M
Complete current address:
(Including city and postal S/O: MUNIRAJ, D/NO. 1/45-1, Period of Stay (DD/MON/YYYY):
code along with two THAMMANRAPALLI, From:
landmarks and landline VTC/PO – MANAAVARNAPALLI, To:
telephone number) NACHIKUMAPAM,
KRISHNAGIRI – 635121
Permanent Address:
(Including city and postal S/O: MUNIRAJ, D/NO. 1/45-1, Period of Stay (DD/MON/YYYY):
code along with two THAMMANRAPALLI, From:
landmarks and landline VTC/PO – MANAAVARNAPALLI, To:
telephone number) NACHIKUMAPAM,
KRISHNAGIRI - 635121
Gender: ✔ Male Female Marital Status: ✔ Single Married
Date of Birth: (DD/MON/YYYY) Nationality: INDIAN
SSN / TIN Number: --
(25/05/2000) (if applicable)
Contact Details Passport Details
Email ID: sundarmba21@[Link] Number: -
Home: - Place of Issue: -
Mobile: 9025811551 Issue date: - Expiry date: -
Photo Identification proof Address proof
Passport ✔ PAN card ✔ Voter card Lease/rental agreement
Driver license ✔ Voter ID Land telephone ✔ Bank statement
(Please attach a copy of the Photo ID proof) (Please attach a copy of the address proof)
I give my consent to IBC Screening Solutions to verify my credential and employment background. I confirm
and undertake that the company shall incur no liability or obligation of any nature whatsoever resulting from
such investigation.
Candidate Signature
27/11/2024
Date
Educational Qualifications
Note: Please attach more educational sheets if necessary
Please complete all the degree/educational qualifications and attach the necessary documents.
Educational Record - Master’s Degree / Highest Degree
(Please attach copy of degree certificate and all year mark sheets)
College Name ER. PERUMAL MANIMEKALAI COLLEGE OF ENGINEERING
College Address and PMC TECH - HOSUR TO KRISHNAGIRI HIGHWAYS,
Contact Telephone NALLAGANAKOTHAPALLI, KONERIPALLI (PO) SHOOLAGIRI,
HOSUR - 635117
University Name, Address, ANNA UNIVERSITY, NO.12, SARDAR PATEL RD, GUNIDY,
and Contact Telephone CHENNAI - 600025
From – To (month / year) Graduated Program Registration/Roll No.
( 2020 -2022) ✔ Yes No ✔ Full Time Part Time 610820631038
Type of degree : Graduation date (month / year) Subject Major
MASTER OF BUSINESS ADMINISTRATION APRIL 2022 HUMAN RESOURCE
Copy of the Certificate Attached ✔ Yes No
Educated in Overseas: ✔ No Yes
If yes, Unique identification number at Overseas (SSN/TIN) : -
Given Name at Overseas: -
Educational Record - Next Highest Degree
(Please attach copy of degree certificate and all year mark sheets)
College Name -
College Address and
Contact Telephone -
University Name, Address, -
and Contact Telephone
From – To Graduated Program Registration/Roll No.
(month / year) Yes No Full Time Part Time
Type of degree Graduation date (month / year) Subject Major
Copy of the Certificate Attached Yes No
Educated in Overseas: No Yes
If yes, Unique identification number at Overseas (SSN/TIN) :
Given Name at Overseas:
Page 2 of 6
Educational Record - DIPLOMA OR ANY
(Please attach copy of degree certificate and all year mark sheets)
College Name ARIGNAR ANNA COLLEGE (ARTS & SCIENCE)
College Address and BILLANAKUPPAM, POLUPALLI(PO), NEAR MEDICAL COLLEGE,
Contact Telephone KRISHNAGIRI - 635115
University Name, Address, PERIYAR UNIVERSITY, PERIYAR, PALKALAI NAGAR,
and Contact Telephone TAMIL NADU - 636011
From – To (month / year) Graduated Program Registration/Roll No.
( 2017 -2020) ✔ Yes No ✔ Full Time Part Time 17UBA2107
Type of degree Graduation date (month / year) Subject Major -
BACHELOR OF BUSINESS ADMINISTRATION APRIL 2020 BUSINESS
ADMINISTRATION
Copy of the Certificate Attached ✔ Yes No
Educated in Overseas: ✔ No Yes
If yes, Unique identification number at Overseas (SSN/TIN) :
Given Name at Overseas:
Educational Record - 12th or PUC or Intermediate or any equivalent to 12th Standard
(Please attach copy of certificate)
School/College Name GOVT HR SEC SCHOOL MANAVARNAPALLI
School/College Address MANAVARNAPALLI, KRISHNAGIRI - 635121
and Contact Telephone
Board Name, Address, STATE BOARD OF TAMIL NADU,
and Contact Telephone MANAVARNAPALLI, KRISHNAGIRI - 635121
From – To (month / year) Passed Program Registration/Roll No.
(2016 – 2017) ✔ Yes No ✔ Full Time Part Time 1710395771
Copy of the Certificate Attached ✔ Yes No
Educated in Overseas: ✔ No Yes
If yes, Unique identification number at Overseas (SSN/TIN) : -
Given Name at Overseas: -
Page 3 of 6
Educational Record - 10th Class or SSLC or any equivalent to 10th Standard
(Please attach copy of certificate)
School Name GOVT HR SEC SCHOOL MANAVARNAPALLI
School Address and MANAVARNAPALLI, KRISHNAGIRI - 635121
Contact Telephone
Board Name, Address, STATE BOARD OF TAMIL NADU,
and Contact Telephone MANAVARNAPALLI, KRISHNAGIRI - 635121
From – To (month / year) Passed Program Registration/Roll No.
(2014- 2015) ✔ Yes No ✔ Full Time Part Time
Copy of the Certificate Attached ✔ Yes No
Educated in Overseas: ✔ No Yes
If yes, Unique identification number at Overseas (SSN/TIN) :
Given Name at Overseas:
Employment Details
Note: Please attach more employment sheets if necessary
.
Please ensure that you are descriptive wherever necessary – For example, if the company no longer
exists, acquired, or merged, please do mention it. Employee Code/ ID/ Number are necessary. If your
previous employer did not provide you one, please mention and provide us with reasons for the same.
Details of Current Employer or Latest Employer
Company Name: OLA ELECTRIC MOBILITY LIMITED
Main office Address: Company Telephone(Landline): -
POCHAMPALLI,
KRISHNAGIRI – 635206 Company Website: OLA ELECTRIC
Reporting (branch) office Address: Employment Period: (DD-MON-YYYY)
POCHAMPALLI, From: (18/09/2023)
KRISHNAGIRI – 635206 To: (19/08/2024)
Job Details Reporting Manager’s Details
Position Held : HR TRAINEE Name : SHEELA
Department: HUMAN RESOURCE Job Title : HR MANAGER
Employee Code: 3117128 Department : HUMAN RESOURCE
SSN (if applicable): Present Contact Number : 7708754219
Employment Type: Permanent ✔ Temporary Official Email ID :Sheela.l@[Link]
Agency Name and Details: (if temporary or contractual) - TEAMLEASE SERVICES LIMITED
Page 4 of 6
Remunerations(Per annum) : 4,00,000 PA Reason(s) for Leaving: FAMILY ISSUE
Is this current employment?: Yes ✔ No
If yes, mention date when the verification can be initiated : (DD-MON-YYYY)
Any other pertinent information:
Details of Previous Employers - Please attach a copy of your relieving letter/service certificate
Company Name: KANSAI NEROLAC PAINTS LIMITED
Main office Address: Company Telephone(Landline):
SIPCOT PHASE II,
HOSUR, Company Website: [Link]
KRISHNAGIRI - 635109
Reporting (branch) office Address: Employment Period: (DD-MON-YYYY)
SIPCOT PHASE II, From: (19/09/2022)
HOSUR, To: (15/09/2023)
KRISHNAGIRI - 635109
Job Details Reporting Manager’s Details
Position Held : HR TRAINEE Name : KARTHIK
Department: HUMAN RESOURCE Job Title : HR EXECUTIVE
Employee Code: GL369 Department : HUMAN RESOURCE
SSN (if applicable): - Present Contact Number : 8807522095
Employment Type: Permanent ✔ Temporary Official Email ID : karthik.m1@[Link]
Agency Name and Details: (if temporary or contractual) - GOODLUCK ENTERPRISES
Remunerations(Per annum) : 2,20,000 PA Reason(s) for Leaving: CAREER GROWTH
Any other pertinent information:
Details of Previous Employers - Please attach a copy of your relieving letter/service certificate
Company Name:
Main office Address: Company Telephone(Landline):
Company Website:
Reporting (branch) office Address: Employment Period: (DD-MON-YYYY)
From:
Page 5 of 6
To:
Job Details Reporting Manager’s Details
Position Held : Name :
Department: Job Title :
Employee Code: Department :
SSN (if applicable): Present Contact Number :
Employment Type: Permanent Official Email ID :
Temporary
Agency Name and Details: (if temporary or contractual)
Remunerations(Per annum) : Reason(s) for Leaving:
Any other pertinent information:
Page 6 of 6
