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Background Verification Form

The document is a background verification form for an employee that collects personal details, residential address history, education records, employment history, and includes an information release form. It collects names, dates of birth, addresses, phone numbers, education qualifications, past employers' details including dates of employment, positions held, supervisors' details, and salaries. The form is used to verify the information provided by the employee and obtain details on their employment record, qualifications, and character from previous employers and authorities.

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varsha.cvc01
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635 views4 pages

Background Verification Form

The document is a background verification form for an employee that collects personal details, residential address history, education records, employment history, and includes an information release form. It collects names, dates of birth, addresses, phone numbers, education qualifications, past employers' details including dates of employment, positions held, supervisors' details, and salaries. The form is used to verify the information provided by the employee and obtain details on their employment record, qualifications, and character from previous employers and authorities.

Uploaded by

varsha.cvc01
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Background Verification Form

Employee Code Employee Location

PERSONAL DETAILS

Name of Applicant
Surname
Middle
First

Maiden Name :

Have you ever been known by □ YES □ NO


another name?
If Yes, please write the other name:

Place of Birth: Date of Birth (dd/mm/yy):

Sex: Nationality:

Father’s Name Passport No. SSN No.


(Mandatory for US address)

Home Phone Office Phone Mobile

RESIDENTIAL ADDRESS

Permanent/Current/Previous Address

City : State :

Pin Code : Nearest Landmark :

Name of the contact person at the address :

Relationship of contact person :

Landline No. Mobile No.

Nature Of Location: Rented/Owned/Others Preferred time of the day for conducting the
verification, if any :

Residing Since (Mandatory): Residing Till ( Mandatory):


EDUCATION RECORD

EDUCATION RECORD (Start with the latest/ highest qualification; please attach photocopies
of the documents ) All fields are mandatory

Name & Name & Address of Type of Dates Attended Roll


Address of University its affiliated Degree/Dipl Number/Regis
School/College/ oma tration
Institute obtained. From To Number/Exam
State “F” for Seat number
fulltime and
“P” for part-
time within
brackets

EMPLOYMENT RECORD
If you are still employed in this organization, please fill in the date before which you would not like the
verification to be initiated in the “To” column. If you are not sure or would like to intimate this date later,
please write 'Still Employed'

Employer 1 Employee From (mm/yy) To (mm/yy)


ID
Full Name

Address Phone Number

City State Country Postal Code

Job Title Reason of Leaving

Designation Final Salary (Annual CTC)

Supervisor Name & Title HR Manager Name

Supervisor ‘s Phone Number HR Manager Phone Number


EMPLOYMENT RECORD

Employer 2 Employee From To (mm/yy)


ID (mm/yy)
Full Name

Address Phone Number

City State Country Postal Code

Job Title Reason of Leaving

Designation Final Salary (Annual CTC)

Supervisor Name & Title HR Manager Name

Supervisor ‘s Phone Number HR Manager Phone Number

EMPLOYMENT RECORD

Employer 3 Employee From To (mm/yy)


ID (mm/yy)
Full Name

Address Phone Number

City State Country Postal Code

Job Title Reason of Leaving

Designation Final Salary (Annual CTC)

Supervisor Name & Title HR Manager Name

Supervisor ‘s Phone Number HR Manager Phone Number


Information Release Form

To Whom It May Concern:

Please print

I
Last name First name Middle name

I hereby authorize KPMG or their representatives to verify information presented on my employment


application/resume and to procure an investigative report or consumer report for that purpose.
I hereby grant authority for the bearer of this letter to access or be provided with full details
 of my previous employment record held by any company or business for whom I previously worked.
This information should include the dates of employment; the nature of the position held, [details of
my salary upon departure] and an appraisal of my performance, capabilities and character. In
addition, please provide any other pertinent information requested by the individual presenting this
authority. I hereby release from liability all persons or entities requesting or supplying such
information.
 of my qualification/degree (copy of my certificates attached)
 information in respect to my character from the records maintained by local authorities

Signature: Date: dd / mm / yyyy

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