BACKGROUND VERIFICATION FORM
Date of Joining:- Designation: -
Name of the Applicant (Full name expanding initials): -
Contact Landline Phone No.:- Mobile Phone No.: - Email Id: -
Father’s Name: - Date of Birth: - Marital Status: -
Single Married
Mother’s Name: - Date of Marriage (If Married): -
Present Residential Address: -
Period of Stay From: - To: - Landmark-
City/Town: - State: - Pin code:-
Contact Landline Phone No.: - Mobile Phone No.: -
Alternate Name and Contact No:- Relation with the Candidate: -
Permanent Residential Address: -
Period of Stay From:- To:- Landmark-
City/Town:- State:- Pin code:-
Contact Landline Phone No.:- Mobile Phone No.:-
Alternate Name and Contact No:- Relation with the Candidate:-
Educational Qualifications: -
Qualification Highest Qualification Qualification Prior to Highest Degree
Type of Degree: -
Specialization (Major Subject): -
Dates Attended: -
Seal/Registration/Enrollment No.:-
Marks/Class Obtained:-
Name of the Institute / College:-
Location (City, State):-
Affiliated University:-
Employment Details: -
Previous Employment Details Prior to Previous Employment
Details
Name of the Company:-
Location (City & State):-
Contact Details:-
If Contract (Name of the Agency
or location:-
Contact Details of Agency:-
Employee Code :-
(Mandatory)
Period of Employment:- Start date Relieving date Start date Relieving date
Designation:-
Last Salary Drawn
(CTC/Gross/Net Amount)
Reporting Manager/ Supervisor
Manager/Supervisor Contact:-
Details and Email Id
HR Manager:-
Contact Details and Email Id:-
Reason of Leaving:-
Exit Formalities Completed:-
(If not specify)
Reference Details:-
(Note: - References of friends and relatives are not considered)
Details Reference 1 Reference 2
Reference Name: -
Presently employed with
Current Company (Yes/No) Yes No Yes No
Designation and Company
Name: -
Contact details: -
(Official/Personal)
Email Id: -
(Official/Personal)
Period for which the candidate
knows the Reference
Relationship with the Candidate
Details Reference 3 Reference 4
Reference Name: -
Presently employed with
Current Company (Yes/ No) Yes No Yes No
Designation and Company
Name:-
Contact details:-
(Official/Personal)
Email Id:-
(Official/Personal)
Period for which the candidate
knows the Reference
Relationship with the Candidate
Declaration (To be signed by the Applicant)
I certify that the information furnished in this form is factually correct and complete in all respects to
the best of my knowledge and belief: -
Name:-
Place/Location:
Date: -
Signature of the Candidate
Declaration and General Consent to Background Investigation
To be signed by the Candidate
In connection with my application to render services to Hays Business Solutions Private Limited
(“Company”), and/or its client("Client(s)”), I hereby agree as follows:
I certify that the information furnished in this form as well as in other forms filled-in by me in the
conjunction with my employment is accurate and factually correct. I hereby authorize Hays Business
Solutions Private Limited, its representatives, and its Clients to verify the information provided and to
conduct enquires as may be necessary.
I understand and acknowledge that an appointment offered to me based on this information be revoked
and/or terminated without notice if any information found to be false, misleading, deliberately
omitted/suppressed.
As a condition of Company’s consideration of my application for employment with the Company and Its
Clients. I hereby give my consent to the Company and its Clients to investigate or cause to be
investigated through and third parties my personal, educational and pre or post-employment history.
I acknowledge that the background investigation may include, but is not limited to, verification of all
information given by me to the Company. I confirm that the Company is entitled to share such
investigation report with its Clients to the extent necessary, in connection with the Services, which I may
be required to provide to such Clients. I confirm and undertake that the Company and its Clients shall
not be liable for any consequences arising from such investigation results.
I certify that I am at present in sound mental and physical condition to undertake employment with Hays
Business Solutions Private Limited and its Clients. I also declare that there is no criminal case filed
against me or pending against me in any Court of Law in India or abroad and no restrictions are placed
on my travelling anywhere in India or abroad purpose of business of the company.
I also give my consent for sharing the given information to third party for business purposes.
I Agree: Yes / No
Name:-
Place/Location:
Date: -
Signature of the Candidate
