EMPLOYEE BACKGROUND CHECK DETAILS AN EQUAL OPPORTUNITY India EMPLOYER

In order that your application may be properly evaluated, it is essential that ALL of the following questions be answered carefully and completely

1. PERSONAL DETAILS

Full Name (First, Middle, Last)

Former Name/Maiden Name (if applicable)

Original color passport size photographs

Fathers Name Date of Birth (dd/mm/yy)

Gender: Male

Female

Social Security Number (if applicable) Email Marital Status

Contact Number Nationality

2. Have you ever worked for CA or any of its divisions before: Yes [

No: [

3. DETAILS OF ADDRESSES Complete Address Current Residential Address (with Prominent Landmark) Permanent Address (if different from current residential address) (with Prominent Landmark)

Period of Stay From (mm/yy) To (mm/yy)

Landline Telephone Number/Mobile No.

4. EMPLOYMENT SECTION
Please give details of all Current/Previous employers covering last (5) years Ensure that you are descriptive wherever necessary e.g. If Co. is closed, do mention it. Employee Code/ ID/ Number are mandatory . If your last employer did not provide one, please mention and state reasons for the same.

Details of Current Employer Company Name (1) : Address (main office and branch where worked): Position Held & Department Telephone:

Employment Period: (date, month, year) From To

Employee Code/ Personnel No:

Name of Reporting Manager:

Designation & Department of Reporting Manager:

Contact No:

Email ID:

SSN No. (mandatory if worked in USA or Canada): Whether employment is of permanent or temporary nature Agency Details (if temporary or contractual) Permanent Temporary

Remunerations

Reason(s) for Leaving

Can a reference be taken now? Yes / No. If no, when can it be taken?

Details of Previous Employers Please attach a copy of

your relieving letter/service certificate

for this

Address (main office and branch where worked):

Telephone:

Employment Period: (date, month, year) From To

Employee Code:

Name of Reporting Manager

Designation & Department of Reporting Manager

Contact No:

Email ID:

Whether employment is of permanent or temporary nature Agency Details (if temporary or contractual) Remunerations

Permanent

Temporary

Reason(s) for Leaving

Details of Previous Employers Please attach a copy of

your relieving letter/service certificate

for this

Employment Period: (date, month, year) From To

Employee Code:

Name of Reporting Manager

Designation & Department of Reporting Manager Whether employment is of permanent or temporary nature Agency Details (if temporary or contractual) Remunerations

Contact No: Permanent

Email ID: Temporary

Reason(s) for Leaving

Note: Please add more boxes if required

5.

EDUCATION QUALIFICATION this )

(Please Attach A Copy Of

Educational Certificates

for

Post Graduation

Professional Qualification

Name of Course College Name and Address University Name and Address Duration of Course Year of Completion Mode of Study (Full Time/Part Time) Roll No/ Enrollment No. SSN No. (if Studied in USA or Canada)

6. PASSPORT RELATED DETAILS (Please ensure a copy of the passport or any other identity document (Ration Card or PAN Card is attached)
Passport No. Place of Issue Date of Issue Expiry Date

7. PLEASE ACCOUNT FOR ANY AND ALL GAPS IN EDUCATION OR EMPLOYMENT DURING YOUR TENURE
From To Reason: Complete Address and Location

From

To

Reason:

Complete Address and Location

8. JOINING DETAILS
Minimum Joining Period Notice Period of Current Employment: Location Preference, if any Location constrains, if any 9. REFERENCES Individuals who have known you well in professional capacity, for example, previous or present colleagues, employers, customers. 1. Name and Designation: Company Phone 2. Name and Designation: Company Phone 3. Name and Designation: Company Phone 4. Name and Designation: Company Phone

1.

Are you currently engaged in any other business either as a proprietor, partner, officer, director, trustee, employee, agent or otherwise? No Yes If yes, please give details. _______________________________________________________________________

2.

Have you ever been arrested for or convicted of a criminal offence? If yes, please give details. _____________________________________________________________________

No

Yes

3.

Have you ever been declared bankrupt? If yes, please give details.

No

Yes

_____________________________________________________________________ 4. Have you ever had any civil judgments made against you ? If yes, please give details. ______________________________________________________________________ 8. Do you know or are you related to anyone who works for the CA? If yes, please give name and relationship ______________________________________________________________________ No Yes

12. CURRENT SALARY DRAWN (Please ensure this is filled in detail)

Signature of Candidate

Date

Location

NOTICE REGARDING APPLICANT BACKGROUND INVESTIGATION IMPORTANT - PLEASE READ CAREFULLY BEFORE SIGNING ATTACHED ACKNOWLEDGEMENT You have applied for employment with Computer Associates ("CA"). It is normal policy for CA to investigate the information contained in each application, and other relevant background information to determine whether the applicant is suitable for a position with CA. We only do this if the applicant consents. If the applicant does not consent, we will not be able to consider his or her application any further. The checks we conduct are limited to publicly available or recorded information and other information that is only available with the applicants written consent please see below for more information. We do not make any other checks. All checks are conducted by a third party and a report is provided to CA. As part of this process you will be given an Employment Application Form to be completed. Upon the receipt of completed Application Form and signed consent letter we will initiate Background Investigation. Please confirm below that you agree to CA carrying out the below mentioned checks. If we do not receive your consent within 7 days, we will not be able to consider your application any further. It is normal practice for your current employer to be contacted during the screening process. It is fully understood that in certain circumstances this may be an area of sensitivity and If you would rather this approach happen at a later stage of the process, then please indicate a date on which we can initiate such contact. DATA PROTECTION NOTICE: If you consent to the checks, you have the following rights: The name of the third party agency which completes these reports for CA is First Advantage Quest Research (FAQR). The information obtained by the third party agency will be passed onto to CA in the form of a report. CA will only retain the information to the extent that it is relevant. If your application is not successful, CA will destroy the information after a reasonable period and not retain copies. The purpose of obtaining the information is to allow CA to verify the details you have provided as part of your application and to understand if there is any other information that would be relevant to a decision to hire you (e.g. if you have a criminal conviction). The information will be kept strictly confidential within CA and only disclosed to the HR, Legal and Security departments as necessary. The following table sets out the information that will be searched:

Tier 1 Executive Level Band 5

Tier 2 Exempt/Hourly Positions Bands 1/2/3/4

Tier 3 Child Development Centre & Similar Sensitive Positions

Residency (last 6 years) Credit Report Past Employment Verification (10 years/previous 3 employers) Criminal History Report *(10 years) Education Verification Asset (property ownership) Search Civil Records Search Company Directorship Check News Media Search

Education Verification Past Employment Verification (5 years/previous 2 employers) Criminal History Report (best available search for region) Database checks

Residency (last 6 years) Credit Report Past Employment Verification (10 years/ previous 3 employers) Advanced Criminal Records Bureau Search Education Verification Personal References

APPLICANT ACKNOWLEDGEMENT AND AUTHORISATION (To Be Completed By Applicant) I acknowledge receipt of the NOTICE REGARDING APPLICANT BACKGROUND INVESTIGATION and I confirm that I have read and understand the above information. I hereby authorise Computer Associates and the named third party to obtain the background information mentioned above for the purposes outlined above. I also hereby release from liability all persons and entities requesting and/or supplying such information in relation to the disclosure of that information, however this release does not extend to the originator of such information for the fairness and accuracy of the information disclosed. ________________________________ Name (First, Middle, Last) ______________________________________ Signature

________________________________________ Date CA has a policy not to discriminate in employment on the basis of age, race, color, religion, sex, ancestry, national origin, citizenship status, marital status or disability.