Azoox Technologies Private Limited

CIN - U26109DL2023PTC420602

Back Ground Verification Form

Applicant No/ Employee ID Location Date of Joining/Interview

Please provide complete and correct information. All fields are mandatory.

Please do not use short forms / abbreviations.

Personal Details

Full Name (First, Middle, Last) Original color passport size

photograph

Former Name(s) / Maiden Name (if applicable) Nationality:

Father’s Name

Social Security Number (if Date of Birth (DD/MM/YY) Gender:

applicable)  Male  Female

Current Address Period of Stay From (mm/yy) To (mm/yy)

Landline Number
ZIP Code

Prominent Landmark Mobile Number

Permanent Address Period of Stay From (mm/yy) To (mm/yy)

Landline Number
ZIP Code

Registered office: Azoox, Plot No. 28, G/F Gali No. 8 Block Z, Uttam Nagar, New Delhi, West Delhi - 110059,
Delhi
Phone: +91-8860394267/8860519410
Azoox Technologies Private Limited

CIN - U26109DL2023PTC420602

Mobile Number
Prominent Landmark

Address with the last Eight

years required with Gaps in the
duration

Period of Stay From (mm/yy) To (mm/yy) Complete Address With Pin Code

From (mm/yy) To (mm/yy) Current Address

ZIP Code

Prominent Landmark

From (mm/yy) To (mm/yy) Current Address

ZIP Code

Prominent Landmark

From (mm/yy) To (mm/yy) Current Address

ZIP Code

Prominent Landmark

Page 2 of 8

Registered office: Azoox, Plot No. 28, G/F Gali No. 8 Block Z, Uttam Nagar, New Delhi, West Delhi - 110059,
Delhi
Phone: +91-8860394267/8860519410
Azoox Technologies Private Limited

CIN - U26109DL2023PTC420602

From (mm/yy) To (mm/yy) Current Address

ZIP Code

Prominent Landmark

Page 3 of 8

Registered office: Azoox, Plot No. 28, G/F Gali No. 8 Block Z, Uttam Nagar, New Delhi, West Delhi - 110059,
Delhi
Phone: +91-8860394267/8860519410
Azoox Technologies Private Limited

CIN - U26109DL2023PTC420602

Education Qualification

Educational Record - Highest Qualification

(Please attach copy of degree certificate and final year mark sheet for this)

College Name
(Mandatory)
College Location
(Mandatory)

University Name
(Mandatory)

From – To Graduated Program Roll No /

(month / year)  Yes  Full Time Enrollment No.
(Mandatory)  No  Part Time (Mandatory)

Type of degree (Mandatory) Graduation date (month Subject Major

/ year) (Mandatory)

Copy of Final Year Mark Sheet & Certificate Attached  Yes  No

SSN No. (mandatory if studied in USA or Canada):

Page 4 of 8

Registered office: Azoox, Plot No. 28, G/F Gali No. 8 Block Z, Uttam Nagar, New Delhi, West Delhi - 110059,
Delhi
Phone: +91-8860394267/8860519410
Azoox Technologies Private Limited

CIN - U26109DL2023PTC420602

Employment Section

Please give details of all previous employers covering last five years
Ensure that you are descriptive wherever necessary – e.g. If Co. is closed, do
mention it. Employee Code/ ID/ Number are mandatory. If your last employer did not
provide one, please mention and state reasons for the same.

Details of Employment Prior to AZOOX Please attach a copy of your relieving letter/service
certificate for this

Company Name (1) : Position Held & Department

Address (main office and branch where worked): Telephone

Employment Period: (date, month, year) Employee Code/ Personnel No:

From (DD/MM/YY) - To (DD/MM/YY)

HR Name HR Contact Number :-

Name of Reporting Manager Contact No of Reporting Manager:

Designation & Department of Reporting Manager Email ID of Reporting Manager:

Whether employment is of permanent or temporary nature -  Permanent  Temporary

Agency Details (if temporary or contractual)

Per Annum Salary Reason(s) for Leaving

Page 5 of 8

Registered office: Azoox, Plot No. 28, G/F Gali No. 8 Block Z, Uttam Nagar, New Delhi, West Delhi - 110059,
Delhi
Phone: +91-8860394267/8860519410
Azoox Technologies Private Limited

CIN - U26109DL2023PTC420602

Details of Previous Employer

Please attach a copy of your relieving letter/service certificate for this
Company Name (2) : Position Held & Department

Address (main office and branch where worked): Telephone

Employment Period: (date, month, year) Employee Code/ Personnel No:

From (DD/MM/YY) - To (DD/MM/YY)

HR Name HR Contact Number

Name of Reporting Manager Contact No of Reporting Manager:

Designation & Department of Reporting Manager Email ID of Reporting Manager:

Whether employment is of permanent or temporary nature -  Permanent  Temporary

Agency Details (if temporary or contractual)

Per Annum Salary Reason(s) for Leaving

Can a reference be taken now? Yes / No.

If no, when can it be taken?

Page 6 of 8

Registered office: Azoox, Plot No. 28, G/F Gali No. 8 Block Z, Uttam Nagar, New Delhi, West Delhi - 110059,
Delhi
Phone: +91-8860394267/8860519410
Azoox Technologies Private Limited

CIN - U26109DL2023PTC420602

Details of Previous Employer

Please attach a copy of your relieving letter/service certificate for this
Company Name (3) : Position Held & Department

Address (main office and branch where worked): Telephone

Employment Period: (date, month, year) Employee Code/ Personnel No:

From (DD/MM/YY) - To (DD/MM/YY)

Name of Reporting Manager Contact No of Reporting Manager:

HR Name HR Contact Number :-

Designation & Department of Reporting Manager Email ID of Reporting Manager:

Whether employment is of permanent or temporary nature -  Permanent  Temporary

Agency Details (if temporary or contractual)

Per Annum Salary Reason(s) for Leaving

Can a reference be taken now? Yes / No.

If no, when can it be taken?

Page 7 of 8

Registered office: Azoox, Plot No. 28, G/F Gali No. 8 Block Z, Uttam Nagar, New Delhi, West Delhi - 110059,
Delhi
Phone: +91-8860394267/8860519410
Azoox Technologies Private Limited

CIN - U26109DL2023PTC420602

Declaration and Authorization

I understand that any employment by Azoox technologies pvt ltd or its affiliated companies is
conditioned upon positive responses from my references, bonding eligibility, continued
adherence to Azoox policies and procedures, applicable rules and regulations and job
performance satisfactory at all times to Azoox .

I consent to take any pre or post-employment examinations as may be required by Azoox or

its representative, and release Azoox from any liability that may arise from such examination.

I authorize an inquiry to be made on the information contained on this application. Former

employers and officials of education institutes, named on this application are authorized to
give information about me and I release them from all liability for issuing such information.

I hereby attest and warrant that all my answers on this application as well as on all forms
completed in conjunction with my employment are true and accurate. I understand that my
misrepresentation of facts, failure to disclose information required on this application or
material change in my information provided which is not reported to Human Resources shall
be cause for dismissal regardless of when discovered by Azoox technologies pvt ltd.

Signed: ________________________

Name in Block Capitals: ________________________

Date: ________________________

Page 8 of 8

Registered office: Azoox, Plot No. 28, G/F Gali No. 8 Block Z, Uttam Nagar, New Delhi, West Delhi - 110059,
Delhi
Phone: +91-8860394267/8860519410