CANDIDATE BACKGROUND CHECK FORM

Please make sure all fields are completely and accurately filled out in print. Always indicate N/A if the required
information is not applicable.

PERSONAL DETAILS
Last name First name Middle name

Other nicknames Date of Birth Civil Status

Nationality Gender Personal e m a i l address

Telephone no. Mobile no. Other contact number/s

Mother's maiden name Father's full name

Spouse's full name

If Employed If studying
Siblings full name Birthdate Occupation Compan Year/Course School
y

PRESENT ADDRESS
Number/Street/Village

State/City/Province Country Postal code

PERMANENT ADDRESS
Number/Street/Village

State/City/Province Country Postal code

 EDUCATION INFORMATION
List information starting from the highest degree obtained.
Name of Institution

Address State/City/Province Country Postal code

Dates attended - From (mm/yyy) To (mm/yyyy)

Graduated? □ YES □ NO Date of graduation (mm/yyyy)

Degree obtained

Name of Institution

Address State/City/Province Country Postal code

Dates attended - From (mm/yyy) To (mm/yyyy)

Graduated? □ YES □ NO Date of graduation (mm/yyyy)

Degree obtained

PROFESSIONAL LICENSES/CERTIFICATION/MEMBERSHIP
List information of professional membership starting from the most recent membership.

Name of institution Date joined Type of membership Membership status

(mm/dd/yyyy)
EMPLOYMENT INFORMATION
List information starti ng from the most recent employer

Name of company Contact number Employee ID No.

Address State/City/Provinc Country Postal code

e
Status o f employment Supervisor name Supervisor contact
number
□ Permanent □ Contractual
□ Probationary

Dates of employment: From (mm/dd/yyyy) To (mm/dd/yyyy)

Can we contact your current If No, please provide reason:

employer?
Job title Department

Job responsibilities

Reason for leaving Last Salary

Name of company Contact number Employee ID No.

Address State/City/Provinc Country Postal code

e
Status o f employment Supervisor name Supervisor contact
number
□ Permanent □ Contractual
□ Probationary

Dates of employment: From (mm/dd/yyyy) To (mm/dd/yyyy)

Can we contact your current If No, please provide reason:

employer?
Job title Department

Job responsibilities

Reason for leaving Last Salary

Name of company Contact number Employee ID No.

Address State/City/Provinc Country Postal code

e
Status o f employment Supervisor name Supervisor contact
number
□ Permanent □ Contractual
□ Probationary

Dates of employment: From (mm/dd/yyyy) To (mm/dd/yyyy)

Can we contact your current If No, please provide reason:

employer?
Job title Department

Job responsibilities

Reason for leaving Last Salary

PERSONAL REFERENCES
Please make sure you list at least 3 previous supervisors, managers, or anyone who had a higher role in your
previous employments. Kindly inform them that MAQ will be getting in touch with them for a quick
reference check within the next few days.

Name Mobile Number(s) Email Adress

Company/ Organization

Position/ Title Relation/ Affiliation

Name Mobile Number(s) Email Adress

Company/ Organization

Position/ Title Relation/ Affiliation

Name Mobile Number(s) Email Adress

Company/ Organization

Position/ Title Relation/ Affiliation

Name Mobile Number(s) Email Adress

Company/ Organization

Position/ Title Relation/ Affiliation

Name Mobile Number(s) Email Adress

Company/ Organization

Position/ Title Relation/ Affiliation

 DECLARATION

I hereby certify that all information provided in this form is accurate and complete at the best of my
knowledge. I understand that any misrepresentation and/or falsification of any fact may result in
cancellation of employment or immediate dismissal.

I recognize that in connection with employment with Transec BPO Solutions, Inc., I may be subject to
a background enquiry and hereby authorize the same.

LETTER OF AUTHORIZATION

I hereby authorize MAQ Research, Inc. to verify information provided in this background check form
for pre-employment purposes. I authorize all persons who may have information relevant to this
enquiry to disclose it to MAQ Research, Inc. and its partners, associates, and to all persons
concerned from liability on account of such disclosure. I hereby voluntarily affixed my signature and
represent this document to be an original.

I further authorize the procurement of a consumer credit report or other like documents and
understand the report may contain information on my background, mode of living, character, and
personal reputation. I further consent to the review and release of any information from my military
records deemed necessary.

I further acknowledge, consent, and agree that photocopies of this Letter of Authorization may be
made and used as if they were original copies.

Complete Name & Signature

Birthday

Date