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Background Verification

This document is a consumer authorization form for a background check. It requests the applicant's signature to acknowledge receipt of a Fair Credit Reporting Act summary. It also requests the applicant's contact information, including a cell phone number and email address, so the background check company can contact the applicant if additional information is needed. The document also includes sections for the applicant to provide their employment history over the past 7 years.

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empireinfolytx
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22 views1 page

Background Verification

This document is a consumer authorization form for a background check. It requests the applicant's signature to acknowledge receipt of a Fair Credit Reporting Act summary. It also requests the applicant's contact information, including a cell phone number and email address, so the background check company can contact the applicant if additional information is needed. The document also includes sections for the applicant to provide their employment history over the past 7 years.

Uploaded by

empireinfolytx
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Copsumer Authorization form (conL) I

dPlease check box acknowledging receipt of the federal Fair Credit Reporting Act Summary of Rights.

A-Check America will need to contact you if additional information is needed to process your Background Investigation. Please
provide a cell and/or alternate phone number and email address where we may contact you.

Cell Phone: f 917 ._) 9637560 — Alternate Phone: (


Email Address: sabbirsourç @gmail.com

Signature: Date: 1 ‘ 1201


(Please do not pe in nan?e; your hand-written signature Lc required above)
Employment Application

Please Tve or Print, Use Ink


/
Last Name First Name Middle Name Social Security Number

Sabbir AKM 503454757

Birth/Maiden or Other Names Used

Sou roy

Present Address City State Zip Code


41st
2520 street Astoria NY 1 1 103

Home Phone (with Area Code) Business Phone

9179637560

EMPLOYMENT RECORD List first the most recently held position, then go back 7 years. May we contact current
employer? Yes fl No El N/A El
Company Name Street Address City State Zip Code

Cygnus Professionals 100, Franklin Square Drive Somerset NJ 08873

From Day/Mo/Yr To Day/Mo/Yr Telephone (with Area Code) Position

May15 2017 Sep 15 2018 (732) 485-0000 Data Scientist

Primary Responsibility Supervisor to include title and contact number

Scaling up data processing system, designing new NLP algorithm Poonam Tubaki, sales manager, 7325332000

Company Name Street Address City State Zip Code

University of Kentucky Lexington KY 40506

From Day/Mo/Yr To Day/Mo/Yr Telephone (with Area Code) Position

28 Aug 2013 16 Dec 2016 (859) 257-9000 Research Assistant


Primary Responsibility Supervisor to include title and contact number

Designing algorithms on complex problems and publish papers and Dr. Ramakanth Kavuluru associate professor,
8594894217 and Dr. Sally Ellingson assistant
journals IrrfQQrr

2 I P a ackformOOl: GRH 3.2013

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