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Background Check Form

Employee Code: ________________

Date of Joining (DD/MM/YYYY) ___________________

Site Joined ____________________

Entity Name (Genpact/Sez) ______________________

COE______________________

Full Name_________________(First)___________________(Mid)_______________(Surname)

Mobile No.___________________

Current Residence

_______________________________________________________________________

________________________________________________________________________

CITY__________________________STATE______________________ PIN_________________

Current Residence Phone No (With STD CODE) ___________________

Date of Birth (DD/MM/YYYY) _________________________

Father’s Name_____________________

Permanent Address

________________________________________________________________________

________________________________________________________________________

CITY__________________________STATE______________________ PIN_________________

Permanent Address Phone No (with STD Code):

LANDMARK_____________________________

Living Since___________________Police Station_______________Post Office________________

Address Proof Attached _____________________________________

(Copy of Passport/Ration Card/PAN Card/Driving License/Phone Bills/Electricity Bills etc which reflects
the permanent Address)
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EDUCATIONAL RECORD - of your education qualification (please attach self-attested

copies of all educational certificate and mark sheets for the same)- Incase studies directly
through the university. Through correspondence or through distance education, please
mention clearly
Sl. No Name & Address of Educational Year of Roll No.
School/College/University. Qualification Passing Regd. No
3. Degree
………………..

4. Diploma/Additional
Qualification
…………………..

5. P.G / Professional
Qualification
………………….

Copy of Certificates Attached Yes No

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

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Employment Information - Ensure that you are descriptive wherever necessary – e.g. If
Company is Closed mention it. Telephone number with specific location code. Employee
Code/ID/ Number are Mandatory. If your previous employer did not provide that letter,
please mention and state reasons for the same.

Employment History: (1)

Details of Employment (Current)

Company Name and location : Last Position Held & Department name:

Telephone: Address (main office and branch where worked):

Employee Code: Period of Employment: (Date / Month / Year)

(If any Break/rejoining, pl specify)

From Till

Reported to (First level) Reported to (Second level)

Name & designation of Supervisor: Name & designation of Supervisor:

Telephone No:
Telephone No:
Mobile No:
Mobile No:
Email Id:
Email Id:

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

Agency Details (if temporary or contractual)

Remunerations / Salary (Per annum – Reason(s) for Leaving

Mention the Fixed & Variable components
separately)

Can a reference be taken now?

Incase of GAP between Employment ( Please Explain):

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Employment History: (2)

Details of Employment (Current)

Company Name and location : Last Position Held & Department name:

Telephone: Address (main office and branch where worked):

Employee Code: Period of Employment: (Date / Month / Year)

(If any Break/rejoining, pl specify)

From Till

Reported to (First level) Reported to (Second level)

Name & designation of Supervisor: Name & designation of Supervisor:

Telephone No:
Telephone No:
Mobile No:
Mobile No:
Email Id:
Email Id:

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

Agency Details (if temporary or contractual)

Remunerations / Salary (Per annum – Reason(s) for Leaving

Mention the Fixed & Variable components
separately)

Can a reference be taken now?

Incase of GAP between Employment ( Please Explain):

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Employment History: (3)

Details of Employment (Current)

Company Name and location : Last Position Held & Department name:

Telephone: Address (main office and branch where worked):

Employee Code: Period of Employment: (Date / Month / Year)

(If any Break/rejoining, pl specify)

From Till

Reported to (First level) Reported to (Second level)

Name & designation of Supervisor: Name & designation of Supervisor:

Telephone No:
Telephone No:
Mobile No:
Mobile No:
Email Id:
Email Id:

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

Agency Details (if temporary or contractual)

Remunerations / Salary (Per annum – Reason(s) for Leaving

Mention the Fixed & Variable components
separately)

Can a reference be taken now?

Incase of GAP between Employment ( Please Explain):

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Letter of Authorization

To whom it may concern

I understand that GENPACT may use an outside agency to verify and validate the information I
have provided including my employment, my personal background, professional standing, work
history and qualifications.

I understand that an outside background agency may obtain information it deems appropriate from
various sources including, but not limited to, the following: current and past employers, criminal
conviction records, school records, College records and professional and personal references.

I authorize, without reservation, any individual, corporation or other private or public entity to
furnish GENPACT and the outside background agency all information about me.

I unconditionally release and hold harmless any individual, corporation, or private or public entity
from any and all causes of action that might arise from furnishing to GENPACT and the outside
agency information that they may request pursuant to this release.

This authorization and release, in original, faxed or photocopied form, shall be valid for this and
any future reports and updates that may be requested.

Signed: ________________________

Name in Block Capitals:

Date of Birth:

Date:
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Information Release Form

To Whom It May Concern:

I ______________________________________________________________________________
LAST NAME FIRST NAME MIDDLE NAME
Hereby authorize GENPACT and any persons or organizations acting on its behalf, 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.

Signature: ______________________________
Date: ____________________________
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FREQUENTLY ASKED QUESTIONS

Please note the below while filling out the Forms

 In case you are a FRESHER, please ignore Page 3.

 Carry the hard copy of the Filled Form along with following Documents on your date
of joining:

o Copy of Address Proof - Copy of Passport/Ration Card/PAN Card/Driving

License/Phone Bills/Electricity Bills etc. Which reflects the permanent Address
o Copy of Accepted resignation letter from your previous employer.
o Copy of relieving letter, Appointment letter & Last 2 salary slip(s) of all
employments mentioned in the form.
o Copy of Highest Qualification Mark sheet/Degree Copy (in case of
undergraduate, Latest Mark sheet or proof of pursuing educating from
College/University)
o 1 Passport size Photograph
o Page 4(LOA) & Page 5(IRF) have to be duly signed in by candidate.

 Fill in the Personal Details & Education Details

 Fill in the Employment Details starting with your Current Company to the
Employment within last 1 year.
 For any queries contact your respective Hiring Manager.