Background Verification Form
**Comprehensive Verification**

(Please Print Clearly and Provide Complete and Accurate Information)

Location:
 
 
Personal Details
 
Full Name: Gender:
(First name, Middle, Last and Last Name)  Male  Female
(Should be as per the PAN Card)
 
Current Address:

City: State:

PIN Code:

Prominent Landmark:

Contact Number: Alternate Contact Number:

   
Period of Stay at Current Address From: To:
If period of stay in current address is less than 6 months please provide permanent address
 

(Complete Address Flat No, Lane, Area, Main, Cross, City, PIN and Landmark is mandatory)
Permanent Address:

City: State: 

PIN Code:  

Prominent Landmark:  

Contact Number:  Alternate Contact Number:

 

   
Telephone (Home): Telephone (Office): Mobile Number :

   
Date of Birth (DD/MM/YYYY): Father’s Name: Nationality :

   
Passport No : E-mail ID: PAN Card No :

 
   
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Educational Qualifications

(IMPORTANT: Copy of mark sheet and degree certificate MUST be attached)

Highest Education

   
College Name

   
College Address

University Name and  

Address 

Graduation date (month /  

year):

Type of degree: Subject:

From (DD-MMM-YY): To (DD-MMM-YY):

Student ID No: Enrollment No:

Graduated  Yes  No Program:  Full Time  Part Time

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Note: Employment details must be shared in descending order for the last 7 years of employment (irrespective
of the number of companies worked for)
 
Employment Details: 01

Details (Last 7 years of employment)

 
Company
 
Name
 
Address &
 
Telephone
    Designation:
Department

 
From  To
Employment
Period
 
Employee
 
Code/ID/No
Supervisor HR Contact
Contact Details Details
& Designation & Designation 
Employment Type:       Agency Details
 Permanent  Contractual  (if contractual) 
 
Remuneration (INR): Reason(s) for Leaving: 

 
 
Employment Details: 02

Details (Last 7 years of employment)

 
Company
 
Name
 

Address &
 
Telephone
    Designation:
Department

 
From  To
Employment
Period
 
Employee
 
Code/ID/No
Supervisor HR Contact
Contact Details Details
& Designation & Designation 
Employment Type:       Agency Details
 Permanent  Contractual 
(if contractual) 
 
Remuneration (INR): Reason(s) for Leaving: 

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Employment Details: 03

Details (Last 7 years of employment)

 
Company
 
Name
 
 
Address &
Telephone
    Designation:
Department

 
From  To
Employment
Period
 
Employee
 
Code/ID/No
Supervisor HR Contact
Contact Details Details
& Designation & Designation 
Employment Type:       Agency Details
 Permanent  Contractual  (if contractual)
 
 
Remuneration (INR): Reason(s) for Leaving: 

Employment Details: 04

Details (Last 7 years of employment)

 
Company
 
Name
 
 
Address &
Telephone
    Designation:
Department

 
From  To
Employment
Period
 
Employee
 
Code/ID/No
Supervisor HR Contact
Contact Details Details
& Designation & Designation 
Employment Type:       Agency Details
 Permanent  Contractual 
(if contractual) 
 
Remuneration (INR): Reason(s) for Leaving: 

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Employment Details: 05

Details (Last 7 years of employment)

 
Company
 
Name
 
Address &
 
Telephone
    Designation:
Department

 
From  To
Employment
Period
 
Employee
 
Code/ID/No
Supervisor HR Contact
Contact Details Details
& Designation & Designation 
Employment Type:       Agency Details
 Permanent  Contractual 
(if contractual) 
 
Remuneration (INR): Reason(s) for Leaving: 

Employment Details: 06

Details (Last 7 years of employment)

 
Company
 
Name
 
Address &
 
Telephone
    Designation:
Department

 
From  To
Employment
Period
 
Employee
 
Code/ID/No
Supervisor HR Contact
Contact Details Details
& Designation & Designation 
Employment Type:       Agency Details
 Permanent  Contractual 
(if contractual) 
 
Remuneration (INR): Reason(s) for Leaving: 

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Letter of Authorization
 
To whom it may concern
 
I hereby authorize First American (India) Private Limited and its representative to verify information
provided in my resume and application of employment, and to conduct enquiries 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 First American (India) Private Limited or its representative. I release all
persons from liability on account of such disclosure.
 
 
Signature

Date

Consent for Drug Test (If applicable) 
I understand that as per the requirement for FAI or its clients. I may need to furnish a sample of my urine
for analysis to undergo certain drug test (the tests as listed in the table 1) which is part of the hiring
process.

I hereby give my consent, without reservation, to FAI and its outside drug testing agency to conduct
such tests.

This consent and release, in-original, -faxed or photocopied form, shall be valid for this and any future
reports and updated that may be requested.

      Table 1: 9 Panel Drug test 

Amphetamines Phencyclidine
Barbiturates Benzodiazepines
Cocaine Methadone
Cannabinoids Propoxyphene
Opiates
 

This Drug tests and authorization have been explained to me: 

Employee Name:  ___________________________________ 

Signature:    ___________________________________ 

Date:      ___________________________________ 

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