BCF FORM - Dataman

BACKGROUND CHECK FORM
Have you served as ………... in dataman

Total Work Experience : earlier?
YES / NO
If yes, mention your Department….
Total Gap (Break) during / between Assigned
Education / Employment : From : To :
Name of the Applicant : Father’s Name:

Blood Group : Father’s Occupation:
Date of Birth (Attach Proof):
Gender (Male/Female) : Spouse Name:
Marital Status : Spouse Occupation:
PAN No :
Aadhar No : Nationality:
Current CTC
Prev. Company Name:
Designation: Expected CTC
Contact Landline Phone No. Mobile Phone No. Email id:
Any Relative/Family If Yes, Department Sibling Details

Member working in
Dataman Yes/No : Designation Brother – Occupation-
Sister- Occupation-
Joining Period : Extensive Travelling (Yes/No):
Conveyance Owned(Yes/No):
A. Present Residential Address : (Attach Proof)
Period of
Stay From : To: Landmark:
City/Town: State: Pin code:
Other Residential Address

Permanent Address : 1: Other Residential Address 2:
From : To: From : To: From : To:
City/Town: City/Town: City/Town:

State: State: State:
Pin code: Pin code: Pin code:
Landmark: Landmark: Landmark:
Point Level of expertise(5-0) Remark
Excellent/Fair/Good/Average
Communication
Level
English
Communication
Presentation
Dedication
Stability
Family Bonding
Kanpur
Other Please Mention
Reference Details:
Details Reference 1 Reference 2
Reference Name (No
Relatives/Friends
to be given as Reference)
Title & Designation:
(Supervisor/Person holding responsible
Position in a Reputed Organization.):
Is the above mentioned Reference/
Supervisor from the current Yes / No Yes / No
Company
Full Address (with Company
Name):
Official email ID:
Landline Telephone /Mobile Phone No.:
Period for which the Reference knows

the
Applicant (Minimum 2 years)
Relationship with the Applicant
(No Relatives/Friends)
Passport Details (Attach Proof):
(i) Name as in Passport:
_____________________________________________________________________
(ii) Passport No : ___________________________ (iii) Place of Issue :
(iv) Date of Issue : ________________________(v)Date of Expiry ______________
Facebook ID :………………………………………………………………
LinkedIn ID :………………………………………………………………
Instagram ID :………………………………………………………………
Educational Qualifications (Attach Proof)
Name as in Certificate:______________________________________________
Examination Name Name of the school Year of Marks Percentage

of the Passing Obtained scored
board
HSC
SSC
Qualification
prior to Highest
Qualification Highest Degree Degree
Mode of Education
(Full time/Correspondence/Partime):
Name of Examination Passed
(B.C.A/M.C.A/B.E./B.Tech./M.Tech/M.B.A,
etc.):
Specialization / Main Subjects:
Name of Institute / College /

University:
Address:
(Give Complete Address)
Institute / City/Town: City/Town:

College /
University State: State:
Details Pin code: Pin code:
Landmark: Landmark:
Office Landline Ph No.:
Name of Affiliated
University:
Affiliated University
Location:
Date From:
Period of
Study Date To:
Seat No. / Roll No./ Regn No.:
Year of Passing:
% of given qualification
Employment Details (Starting from your Current/Immediate Last
Employment) (Attach Proof):
Name of the Company :
Previous Employer’s Current Previous
Description Company Employment 1
Date of emp.
Period From:
Date of emp.
To:
Employee Designation:
Details Employee #:
HR HR Name:
HR
Details Designation:
Office
Landline Ph
No.:
Email:
Supervisor
Supervisor Name:
Supervisor
Details Designation:
Do not
Office provide Do not
Landline Ph Mobile Ph provide
No.: No Mobile Ph No
Email:
Last drawn
CTC:
Reasons for
leaving:
Employer
Employer Name:
Details
From Date
To Date
Address: (Give
Complete
Address incl.
Postal
Town/City: Town/City:
State:
Pin Code: State: Pin Code:
Gaps during Education/Employment (Attach Proof):
From To Reasons for gap
Gap Period 1
Gap Period 2
Gap Period 3
SECURITY DETAILS:
A, Are you involved in any pending and / or closed Civil / Criminal

/ case / proceedings / charges / enquiry prior to joining
Dataman ?
Yes / No
B, Are you involved in any pending and / or closed Disciplinary /
malpractices and / or any other charges / proceedings / enquiry /
case pending against me in any University or any other educational
authority / institution prior to joining Dataman ?
Yes / No
C, If the answer to any of the above mentioned questions is ‘ Yes’ give full particulars of the
case /arrest / detention / fine / conviction / sentence / punishment etc. and / or the nature of
the case pending in the Court / University / Educational Authority etc., at the time of filling up
this form.(Attach additional sheet, if required)
DECLARATION (To be signed by the Applicant)
I certify that the information furnished in this form is factually correct and complete in
all respects to the best of my knowledge and belief.
Signature of Applicant __________________ Name ___________________________
Place _____________________ Date ___________________________________

Declaration to be signed by the Candidate
I hereby agree as follows:
I certify that the information furnished in this form as well as in all other forms filled-in by me in
conjunction with my rendering of services as a………………………. is factually correct and subject
to verification by Dataman including Reference Check and Background Verification.
I accept that my services as a …………………………………. can be revoked and/ or terminated

without any notice at any time in future if any information has been found to be false, misleading,
deliberately omitted/ suppressed.
I also declare that there is no criminal case filed against me or pending against me in any Court of law
in India or abroad and no restrictions are placed on my travelling anywhere in India or abroad for the
purpose of business of the company.
I hereby declare and undertake that
I shall not resort to any unethical, unfair practices to augment my chances of selection with Dataman
by adopting unlawful means directly and / or indirectly within and outside Dataman and shall strictly
adhere to the selection process made applicable by Dataman.
My candidature for Contract Services in the Company is liable to be rejected in the event it comes to
the knowledge of Dataman that I have resorted to unethical, unfair practices to augment my chances
of selection with Dataman. I am fully aware that Dataman is an equal opportunity employer and the
decision of Dataman to hire me is solely will be made on my credentials duly validated and on the
assessment of my capability to perform a role for which I am interviewed by Dataman.
I Agree : Yes
Name: …………………………………………………………… Date : ……………………………………
Signature: …………………………………………………………
Relevant Specialization Details
For .Net Frameworks
Stream Working Experience Level of expertise

in Months Excellent/Fair/Good/Average
VB.Net
ASP.Net
C#
MVC
Angular JS
Reactjs
HTML5 and
Bootstrap
MS-SQL Server
MS-Access
VBA
Excel Programming
Power BI
C++
Socket Programming
Python
Crystal Reports
Sharepoint
SSRS/SSIS
Microsoft CRM
Microsoft NAV
D365
VSCode IDE
Azure
Relevant Specialization Details
For Open Source Technology
Stream Working Experience Level of expertise

in Months Excellent/Fair/Good/Average
JAVA
J2EE
GWT
Angular JS
Reactjs
HTML5 and
Bootstrap
Node.Js
Vue.js
React Native
Flutter and Dart
SAP Reports
C++
PhoneGap
Python
MySql
Mongo DB
PostGresSql
SQLLite
Magento
WordPress
Drupal
Adobe
PHP

BCF FORM - Dataman

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BACKGROUND CHECK FORM

Have you served as ………... in dataman

Name of the Applicant : Father’s Name:

Contact Landline Phone No. Mobile Phone No. Email id:

Any Relative/Family If Yes, Department Sibling Details

City/Town: State: Pin code:

Other Residential Address

City/Town: City/Town: City/Town:

Official email ID:

Landline Telephone /Mobile Phone No.:

Period for which the Reference knows

Examination Name Name of the school Year of Marks Percentage

Specialization / Main Subjects:

Name of Institute / College /

Institute / City/Town: City/Town:

A, Are you involved in any pending and / or closed Civil / Criminal

DECLARATION (To be signed by the Applicant)

Signature of Applicant __________________ Name ___________________________

Place _____________________ Date ___________________________________

I hereby agree as follows:

I accept that my services as a …………………………………. can be revoked and/ or terminated

I hereby declare and undertake that

Name: …………………………………………………………… Date : ……………………………………

For .Net Frameworks

Stream Working Experience Level of expertise

For Open Source Technology

Stream Working Experience Level of expertise

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Signature of Applicant Name _________

Place _ Date _______________