Scribd
Upload
88 views

Background Verification Form

This background verification form collects personal and employment details from an applicant. It requests information such as the applicant's name, date of birth, education history, employment history for the past 10 years, and documents required for verification like degree certificates and experience letters. The applicant must declare that the information provided is true and complete, and authorizes the company to conduct background checks and verify the details with past employers, colleges and references.

Uploaded by

Umesh Tyagi
Copyright
© © All Rights Reserved
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
88 views

Background Verification Form

This background verification form collects personal and employment details from an applicant. It requests information such as the applicant's name, date of birth, education history, employment history for the past 10 years, and documents required for verification like degree certificates and experience letters. The applicant must declare that the information provided is true and complete, and authorizes the company to conduct background checks and verify the details with past employers, colleges and references.

Uploaded by

Umesh Tyagi
Copyright
© © All Rights Reserved
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
You are on page 1/ 6

Background Verification Form

Please Print Clearly and Provide Complete and Accurate Information


Note - All fields are mandatory, please do not leave any blanks

Personal Details
Full Name (First, Middle, Last) :
Former Name(s) / Maiden Name (if applicable)

Gender: Female
Date of Birth::5-8-1989

Fathers Name :
Legal Entity :

Educational Qualifications
Post Graduation Education 1
College Name (1)
College Address
University Name and
Address
From To

Graduated

(month / year)

Yes
No
Pursuing

Type of degree

Program
Full Time
Part Time
Graduation date (month /

Roll No __________
Enrollment No. __________
Hall Ticket No __________
Registration No __________
Others __________
Subject Major

year)

Graduation Education 2
College Name (1)
College Address
University Name and
Address
From To

Graduated

(month / year)

Yes
No
Pursuing

Type of degree

Program
Full Time
Part Time
Graduation date (month /
year)

Roll No __________
Enrollment No. __________
Hall Ticket No __________
Registration No __________
Others __________
Subject Major

Deloitte U.S. India[1] entities

Highest Professional Qualification Education 3


College Name (1)
College Address
University Name and
Address
From To

(month / year)

Graduated

Program

Yes
No

Roll No __________
Enrollment No. __________
Hall Ticket No __________
Registration No __________
Others __________

Full Time
Part Time

Type of degree

Graduation date (month /

Membership #

year)

Employment History
Details of Current or Last Employer
Company Name (1) :

Position Held :
Department :

Address :

Telephone:

(main office and branch where worked):

Employment Period: (date, month, year)


From:

To:

Employee
Code:

Reporting details:
Name :
Position :

Whether employment is of permanent or temporary nature - Permanent Temporary


Agency Details (if temporary or contractual) :
Remunerations / Salary
[CTC / Gross per month]

Reason(s) for Leaving:

Deloitte U.S. India[1] entities

Details of Previous Employers (covering last 10 years)


Company Name (1) :

Position Held :
Department :

Address :

Telephone:

(main office and branch where worked):

Employment Period: (date, month, year)


From:

Employee
Code:

To:

Reporting details:
Name :
Position :

Whether employment is of permanent or temporary nature - Permanent Temporary


Agency Details (if temporary or contractual) :
Remunerations / Salary

Reason(s) for Leaving:

[CTC / Gross per month]

Details of Previous Employers (covering last 10 years)


Company Name (1) :

Position Held :
Department :

Address :

Telephone:

(main office and branch where worked):

Employment Period: (date, month, year)


From:

Employee
Code:

To:

Reporting details:
Name :
Position :

Whether employment is of permanent or temporary nature - Permanent Temporary


Agency Details (if temporary or contractual) :
Remunerations / Salary

Reason(s) for Leaving:

[CTC / Gross per month]

Documents Required
Note : Requested to submit on the day of Joining

For Education Verification:


Final year Mark sheet
Convocation / Provisional Certificate
For Bangalore University:

A Photo Copy of both the sides of the Degree Certificate (The reverse side of the certificate has
some information which the University would require).
Copies of the Marks Sheets/Grade Card for all the years of attendance.
Name of the College through which the candidate has graduated.)

For Employment Verification:


Photocopy of relieving / experience certificate

Deloitte U.S. India[1] entities

Pay slip

Deloitte U.S. India[1] entities

Declaration
I hereby certify all of the statements made and information provided during the Deloitte U.S. India[1]
entities employment application and interview process (including your Curricula Vitae (CV)) are
true and complete and I understand that omission or misrepresentation of any fact may result in
refusal of employment or immediate dismissal.
I recognize that in connection with employment with Deloitte U.S. India[1] entities, I may be the
subject of a background enquiry by Deloitte U.S. India[1] entities or its representative, an outside
agency, and I hereby authorize the same.
Signed

____________________________________

[Name if sending the soft copy]

Name in Block Capitals

____________________________________

Date

____________________________________

Authorization
I understand that Deloitte U.S. India[1] entities. may use an outside agency to verify and validate the
information I have provided including my employment, my professional standing, work history
and qualifications.
I understand that an outside background agency may obtain information it deems appropriate
from various sources including, but not limited to, the following current and past employers,
college records and professional and personal references.
I authorize, without reservation, any individual, corporation or other private or public entity to
furnish Deloitte U.S. India[1] entities . and the outside background agency all information about me.
I unconditionally release and hold harmless any individual, corporation, or private or public entity
from any and all causes of action that might arise from furnishing to Deloitte U.S. India[1] entities .
and the outside agency, information that they may request pursuant to this release.
This authorization and release, in original, faxed or photocopied form, shall be valid for this and
any future reports and updates that may be requested.
Signed

____________________________________

[Name if sending the soft copy]

Name in Block Capitals

____________________________________

Date

____________________________________

[
[

[1]

As used in this page, "Deloitte U.S. India" means Deloitte & Touche Assurance & Enterprise Risk Services India Private Limited,
Deloitte Consulting India Private Limited , Deloitte Financial Advisory Services India Private Limited, Deloitte Tax Services India
Private Limited and Deloitte Support Services India Private Limited
[
[
[

Deloitte U.S. India[1] entities

You might also like