Background Verification Form

Ritepick HR Solutions Private
We Authenticate Your Hire
Background Verification Form

Instructions: Please provide all the information requested in this form. Incomplete Background
Verification Forms (BVFs) will be returned. All supporting documents must accompany this form.
Photocopies must be legible. We have included a checklist to assist you to complete your application
comprehensively.
PERSONAL DETAILS
Full Name (First/Middle/Last): _ DIGANTO GOSWAMI
(BLOCK LETTERS)
Fathers Name: BHAVES CHANDRA GOSWAMI
Date of birth (DD/MM/YY):_ 24/12/86 Personal Number:□_

Nationality: INDIAN _ Passport Number: Z2747208 Date of issue: 06/03/2014 _Date of expiry:
05/03/2024_ Social Security Number (If worked/studied in the US/Any other Country)
_
Change of Name if Applicable
Former Name/Maiden Name

__ _
Date of Name Change _
Current Address
Door No/Street:_ _ Flat# A1, House# H4/46, MAHAVIR ENCLAVE, PALAM DABRI ROAD, NEW DELHI 110045 City:_ NEW
DELHI
State DELHI: Pin: 110045 _ Landmark:_ SULABH INTERNATIONA _
Period of Stay: 20 YEARS
□: (Landline)
Is your residence your own or a rented place? _OWN
If rented, please provide details of the Landlord Name: NA _ Address: NA
City: NA _ State: NA Pin: NA
□: (Landline)
EDUCATION DETAILS
A: Graduation
DR. MGR EDUCATIONAL & RESEARCH INSTITUTE
Name of College/Study Centre
DR. MGR UNIVERSITY

Name of Board / University
City:CHENNAI State: TAMIL NADU

Address of College/Study Centre
Pin:600095 □: (Landline) 044 2378 2176
□: (Email ID)
E04BCS1044 4 years
Student ID No:/ Enrolment No Period of Study
2008
Division / Class Degree Obtained
COMPUTER SCIENCE Course Type FULL TIME (REGULAR)

Subject Major (Regular/Distance
B: Post Graduation NA
NA
NA
City: State:
Pin: □: (Landline)
□: (Email ID)

Course Type
C: Certification Course
City: State:
Pin: □: (Landline)
□: (Email ID)

Course Type
Note: Please attach legible Xerox copies of the following documents relevant to the entries above
1) Mark sheets of all semesters/years 2) Degree Certificate, FRONT and BACK
3) Provisional Certificate
We Authenticate Your
Hire
EMPLOYMENT
NOTE: There are two categories in each form. Please provide information under the relevant Employment Category.
Current Employment
Name of Company COGNIZANT TECHNOLOGY SOLUTIONS
Where were you employed? ❑ Registered Corporate ■ Branch Office

Office
Company Address Building No-10 Sea view Developers Ltd Plot No-20 & 21 INFOSPACE, Sector 135, Bajidpur,
Uttar Pradesh 201304
(Where you were employed )
□ (Contact Details) 1800 208 6999

Period of employment 9 months Employee Code 913468
Designation and Department SAP Remuneration 2500000

Logeshwari MANAGER 7094788913
Supervisor’s Name and Designation □ (Phone No. &
Email Id)
career opportunities
Reason for leaving
Can a reference be taken now? ■ Yes ❑ No
If No, when can it be taken?

Type of Employment, If
■ Permanent
contractual employment, please
mention the Agency details
below. ❑ Contractual / Temporary
CONTRACTUAL / DEPUTED FROM / AGENCY DETAILS

Company Name
Company Address Door No/Street
City State
Company Contact Person □ (Email Id)
Designation □ (Landline)
1) Appointment Letter 2) Salary Slip 3) Release Letter
Hire
EMPLOYMENT
First Previous Employment

Name of Company COGNIZANT TECHNOLOGY SOLUTIONS

Office
Company Address Building No-10 Sea view Developers Ltd Plot No-20 & 21 INFOSPACE, Sector 135, Bajidpur,
Uttar Pradesh 201304
□ (Contact Details)
Period of employment 9 months Employee Code
Designation and Department SAP Remuneration
Logeshwari MANAGER
Email Id)
career opportunities
Reason for leaving
Can a reference be taken now? ■ Yes ❑ No

■ Permanent

Company Name
City State
Hire
EMPLOYMENT
Second Previous Employment

Name of Company EA GATEWAYS

Office
EA GATEWAYS
Company Address
1st Floor, Plot 3-97, Ayappa Society main road, Madhapur,
(Where you were employed ) Hitech City, Hyderabad, Telangana 500081, India.
□ (Contact Details)
Period of employment 4 Months Employee Code EAG/C1120001
Designation and Department Senior consultant Remuneration 150000 / month

K Ashok Kumar (DIRECTOR)
Email Id)
Career Opportunities
Reason for leaving
Can a reference be taken now? ❑ Yes ■ No
Number Lost
■ Permanent

Company Name
City State
Hire
EMPLOYMENT
Third Previous Employment

Name of Company GYANSYS

Office
Company Address D NO 1-1-537/A Gandhi Nagar, Hyderabad, Telangana-500080, CIN: U72200TG2006PTC050903

□ (Contact Details) +91 8045119900
Period of employment 5 Months Employee Code 1021
Designation and Department SAP Remuneration 130000 per month

NA
Supervisor’s Name and Designation Rajeev Subudhi □ (Phone No. &
Email Id)
(Director)
Career Opportunities
Reason for leaving
Can a reference be taken now? ❑ Yes ■ No
Lost Number
■ Permanent

Company Name
City State
REFERENCE DETAILS:
Note: Other than Relatives/ Friends, with whom you have either worked or have received professional education
Reference 1 Reference 2 Reference 3

Logeshwari Marco Kirti
Name
Organization/ COGNIZANT Siegwerk SIEGWERK

Institution
MANAGER MANAGER HR
Position
Chennai Columbia GURGAON

Address
7094788913 +52 55 79747731 9015770637

Telephone No.
Manager Colleague HR
Relationship
Years you have 1 year 1.5 years 1.5 years

know each other
Authorization/ Declaration and
Undertaking
If Employed by SUMMITWORKS, I agree to provide copies of all relevant certificates. I understand that employment
with SUMMITWORKS is governed by their employment policies as applicable, including satisfactory information from background
checks.
I hereby certify that all information provided herein is true and complete to the best of my knowledge and belief. I authorize _
SUMMITWORKS and its representative to authenticate information I have provided in my resume and this Background
Verification Form(BVF). To conduct enquiries as may be necessary at the Company’s discretion; I authorize all who may have information
relevant to this enquiry to disclose it to
and / or its representative. I release all concerned from any liability on account of such disclosures
I also declare that the information provided by me in my resume and application for employment to
SUMMITWORKS_ _and its representative is authentic and I am liable for all inaccuracies and omissions.
I promise to extend total co-operation and provide relevant documents required.
Full Name of the Candidate: DIGANTO GOSWAMI
Place: _ NEW DELHI
Date: _
18/01/2022
Signature of the Candidate

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Ritepick HR Solutions Private

We Authenticate Your Hire

Date of birth (DD/MM/YY):_ 24/12/86 Personal Number:□_

Former Name/Maiden Name

DR. MGR UNIVERSITY

City:CHENNAI State: TAMIL NADU

COMPUTER SCIENCE Course Type FULL TIME (REGULAR)

Student ID No:/ Enrolment No Period of Study

Division / Class Degree Obtained

Name of Board / University

Student ID No:/ Enrolment No Period of Study

Division / Class Degree Obtained

Where were you employed? ❑ Registered Corporate ■ Branch Office

□ (Contact Details) 1800 208 6999

Designation and Department SAP Remuneration 2500000

If No, when can it be taken?

CONTRACTUAL / DEPUTED FROM / AGENCY DETAILS

First Previous Employment

Where were you employed? ❑ Registered Corporate ■ Branch Office

If No, when can it be taken?

CONTRACTUAL / DEPUTED FROM / AGENCY DETAILS

Second Previous Employment

Where were you employed? ❑ Registered Corporate ■ Branch Office

Designation and Department Senior consultant Remuneration 150000 / month

CONTRACTUAL / DEPUTED FROM / AGENCY DETAILS

Third Previous Employment

Where were you employed? ❑ Registered Corporate ■ Branch Office

Company Address D NO 1-1-537/A Gandhi Nagar, Hyderabad, Telangana-500080, CIN: U72200TG2006PTC050903

□ (Contact Details) +91 8045119900

Period of employment 5 Months Employee Code 1021

Designation and Department SAP Remuneration 130000 per month

CONTRACTUAL / DEPUTED FROM / AGENCY DETAILS

Reference 1 Reference 2 Reference 3

Organization/ COGNIZANT Siegwerk SIEGWERK

Chennai Columbia GURGAON

7094788913 +52 55 79747731 9015770637

Years you have 1 year 1.5 years 1.5 years

I promise to extend total co-operation and provide relevant documents required.

Full Name of the Candidate: DIGANTO GOSWAMI

Place: _ NEW DELHI

Signature of the Candidate

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