EMPLOYMENT VERIFICATION FORM

Employee ID:
DATE OF JOINING:

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

Please do not use short forms/Abbreviations.

Please fill up this form in uppercase letters and take a printout.

Hardcopy of this form along-with Supporting Documents has be Submitted (Duly
signed and with a Photograph) to your Location Contact Point.

PERSONAL DETAILS

Title (Mr.) (First) (Middle)

Name (Last)

Father’s Name:

Nationality Indian

Date of Birth
(yyyy/mm/dd)

Gender:
Male Marital Status:
married
Female
Unmarried

Maiden Name (applicable for married ladies)

COMMUNICATION ADDRESS

Present Address:
Period of Stay:

Land Mark: PINCODE:

Current Address:

Landmark: PINCODE:
EDUCATIONAL RECORD-of your highest and completed education qualification (Please
attach Self-attested copy of degree certificate and mark sheet for this)-Incase studied
directly through the university, though correspondence or through distance education,
please mention clearly.
College
Name/Address

University Name/
Address

From To (Month/Yr) Graduated Program %/ Student Id

(Month/yr) Class No./Enrolment
No.
Yes Full-Time

Type of Degree Graduation Subject Major

certificate Date
Copy of Certificate Attached Yes
Social Security Number (Mandatory if Studied in U.S.A)

EDUCATIONAL RECORD-of your Secondary and completed education

qualification (Please attach Self-attested copy of degree certificate and mark
sheet for this)-Incase studied directly through the university, though
correspondence or through distance education, please mention clearly.

College
Name/Address

University Name/
Address
From To Graduated Program %/ Student Id
Class No./Enrolment
No.
Yes Full-
Time

Type of Graduation Subject Major

certificate Date
Diploma
Copy of Certificate Attached

Social Security Number (Mandatory if Studied in U.S.A)

EMPLOYMENT SECTION: Please give the details of last employment. Ensure that
you are descriptive wherever necessary-e.g. If Co. is closed do mention it.
Telephone number with specific location code. Employee Code/ID/Number is
Mandatory. If your previous employer did not provide the latter, please mention
and state reasons for the same.

EMPLOYMENT 1 (LATEST)

Employment History-Please attach a self attested copy of your relieving

letter/Service certificate for this. Please do not use abbreviations for
company names.

Company Name: Position Held:

Address : Company
Telephone:

Employment Period Reported to Name of HR

(Name &
Position):

Whether employment is of permanent or temporary nature (Contract

positions are temporary)

Permanent Employee Code/Personnel No:

Social Security Number (Mandatory if worked in USA):

Responsibilities:

Last Monthly Gross Salary Reasons for Leaving

(Please attach the self-attested copy

of your last pay slip.)
Can verification be done now? Yes

If No, When can it be done?

EMPLOYMENT SECTION: Please give the details of last employment. Ensure that
you are descriptive wherever necessary-e.g. If Co. is closed do mention it.
Telephone number with specific location code. Employee Code/ID/Number is
Mandatory. If your previous employer did not provide the latter, please mention
and state reasons for the same.

EMPLOYMENT 2 (LATEST)

Employment History-Please attach a self attested copy of your relieving

letter/Service certificate for this. Please do not use abbreviations for
company names.

Company Name: Position Held:

Address (main office and branch Company

where worked) Telephone:

Employment Period (yyyy/mm/dd) Reported to Name of HR

(Name & Manager
Position):

Whether employment is of permanent or temporary nature (Contract

positions are temporary)

Permanent Temporary Employee Code/Personnel No:

Social Security Number (Mandatory if worked in USA):

Responsibilities:

Last Monthly Gross Salary Reasons for Leaving

(Please attach the self-attested copy

of your last pay slip.)
Can verification be done now? Yes No

If No, When can it be done?

EMPLOYMENT SECTION: Please give the details of last employment. Ensure that
you are descriptive wherever necessary-e.g. If Co. is closed do mention it.
Telephone number with specific location code. Employee Code/ID/Number is
Mandatory. If your previous employer did not provide the latter, please mention
and state reasons for the same.

EMPLOYMENT 3 (LATEST)

Employment History-Please attach a self attested copy of your relieving

letter/Service certificate for this. Please do not use abbreviations for
company names.

Company Name: Position Held:

Address (main office and branch Company

where worked) Telephone:

Employment Period (yyyy/mm/dd) Reported to Name of HR

(Name & Manager
Position):

Whether employment is of permanent or temporary nature (Contract

positions are temporary)

Permanent Temporary Employee Code/Personnel No:

Social Security Number (Mandatory if worked in USA):

Responsibilities:

Last Monthly Gross Salary Reasons for Leaving

(Please attach the self-attested copy

of your last pay slip.)
Can verification be done now? Yes No

If No, When can it be done?

EMPLOYMENT 4 (LATEST)

Employment History-Please attach a self attested copy of your relieving

letter/Service certificate for this. Please do not use abbreviations for
company names.

Company Name: Position Held:

Address : Company
Telephone:

Employment Period Reported to Name of HR

(Name &
Position):

Whether employment is of permanent or temporary nature (Contract

positions are temporary)

Permanent Employee Code/Personnel No:

Social Security Number (Mandatory if worked in USA):

Responsibilities:

Last Monthly Gross Salary Reasons for Leaving

(Please attach the self-attested copy

of your last pay slip.)
Can verification be done now? Yes

If No, When can it be done?

EMPLOYMENT 5 (LATEST)

Employment History-Please attach a self attested copy of your relieving

letter/Service certificate for this. Please do not use abbreviations for
company names.

Company Name: Position Held:

Address : Company
Telephone:

Employment Period Reported to Name of HR

(Name &
Position):

Whether employment is of permanent or temporary nature (Contract

positions are temporary)

Permanent Employee Code/Personnel No:

Social Security Number (Mandatory if worked in USA):

Responsibilities:

Last Monthly Gross Salary Reasons for Leaving

(Please attach the self-attested copy

of your last pay slip.)
Can verification be done now? Yes

If No, When can it be done?

EMPLOYMENT 6 (LATEST)

Employment History-Please attach a self attested copy of your relieving

letter/Service certificate for this. Please do not use abbreviations for
company names.

Company Name: Position Held:

Address : Company
Telephone:

Employment Period Reported to Name of HR

(Name &
Position):

Whether employment is of permanent or temporary nature (Contract

positions are temporary)

Permanent Employee Code/Personnel No:

Social Security Number (Mandatory if worked in USA):

Responsibilities:

Last Monthly Gross Salary Reasons for Leaving

(Please attach the self-attested copy

of your last pay slip.)
 Kindly share your past 7 years stay address in below format for Database check(Jan 2010
to till date).

Period Of Stay (month & year)

Sl Nos Complete Address State Pin Code
From: (mm/yy) To : (mm/yy)

7
 PROFESSIONAL REFERENCE CHECK

Professional Reference Verification

Professional Reference 1
Supervisor Contact details:
Name of the Supervisor/Reporting Manager
Communication Skills
Effectiveness in meeting goals and objectives
Professional Strength
Professional weakness
Ability to withstand pressure
People Management Skills
Reliability
Honesty
Any Records regarding misrepresentation of facts or
accounts
Attendance and punctuality
Eligibility for rehire
Mode of exit
Job performance rating on a scale of 1 to 10
Additional comments

Mode of Verification
Date of Check Completed
Professional Reference Verification
Professional Reference 2
Supervisor Contact details:
Name of the Supervisor/Reporting Manager
Communication Skills
Effectiveness in meeting goals and objectives
Professional Strength
Professional weakness
Ability to withstand pressure
People Management Skills
Reliability
Honesty
Any Records regarding misrepresentation of facts or
accounts
Attendance and punctuality
Eligibility for rehire
Mode of exit
Job performance rating on a scale of 1 to 10
Additional comments

Mode of Verification
Date of Check Completed
 Declaration

I hereby certify all of the statements made on the (CLIENT NAME) employment
verification form are true and complete and I understand that omission or
misrepresentation of any fact may result in refusal of employment or immediate
dismissal.

I recognize that in connection with employment with (CLIENT NAME). I may be

the subject of a background enquiry by CLIENT NAME or its representative and I
hereby authorize the same.

Signature :

Name in Capital : BATTALA THIRUPATHAIAH

Date : 17-12-2024
 Letter of Authorization

To whom it may concern

I hereby authorize CLIENT NAME representative to verify information provided in

my resume and application of employment and to conduct enquiries as may be
necessary at the company’s discretion. I authorize all persons who may have
information relevant to this enquiry to disclose it to CLIENT NAME or its
representative. I realize all persons from liability on account of such disclosure.

Signature :

Name in Capital : BATTALA THIRUPATHAIAH

Date : 17-12-2024