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Background Verification Form Format

The document is a Background Screening Form for candidates applying to Integrity Verification Service Private Limited. It collects personal details, education history, employment history, and professional references, along with an authorization letter for information verification. Candidates are required to provide specific documentation and contact details for their previous employers and references.

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Mani Kandan
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18 views6 pages

Background Verification Form Format

The document is a Background Screening Form for candidates applying to Integrity Verification Service Private Limited. It collects personal details, education history, employment history, and professional references, along with an authorization letter for information verification. Candidates are required to provide specific documentation and contact details for their previous employers and references.

Uploaded by

Mani Kandan
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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3rd Floor, Cambata Building, Above Eros Theatre, Jamshedji Tata Road, Churchgate, Mumbai – 400020.

www.integrityvs.com

Background Screening Form

CANDIDATE PERSONAL DETAILS

Applicant ID: IVS/MUM/


Full Name

Former Name(s) /
Maiden Name (If
applicable)
Father’s Name
Address 1: Current: 

Address 2: Permanent: 

Gender: Male  Female  Date of Birth: (DD/MM/YY)

Contact number

PAN Card number


3rd Floor, Cambata Building, Above Eros Theatre, Jamshedji Tata Road, Churchgate, Mumbai – 400020.
www.integrityvs.com

EDUCATION HISTORY (Highest Qualification Onwards)

Board / Full time/ Seat / Roll/ Course Course


Exam
School/college University part time/ Registration Start End % Ach
Passed
and address affiliate to Distance number Date Date

Any other information you would like to provide (if any) : ______________________________________

Attention:
 Please mention any details for re examination taken directly from the University or anything else you
would like to highlight.
 Please mention if you have attained qualification with correspondence studies and also enclose copy
mark sheet with roll no. clearly indicated.
 Please provide clear copy of the Final Year mark sheet / certificates for the education qualification
mentioned above.

EMPLOYMENT HISTORY 1 (Previous Employer)

Company Name :
3rd Floor, Cambata Building, Above Eros Theatre, Jamshedji Tata Road, Churchgate, Mumbai – 400020.
www.integrityvs.com

Address (Main Office and Branch where worked):

Company Board Line Numbers (No Cell


Phone numbers accepted)
If Deputed by Agency - Agency name
and address

Tel no of the Agency


Employee Code
Designation and Dept
Date of Joining
Date of Leaving
Monthly Gross Salary
Reasons For leaving
Supervisor’s Name and Designation

Supervisor’s Official Mail ID

Supervisor's direct Line Number and


Mobile no.

Any other information you would like to provide:

Attention:
 Please provide the Employee Code mandatorily and clearly
 Please provide a copy of the last Salary Slip of your Current Employer

EMPLOYMENT HISTORY 2 (Previous Employer)

Company Name :

Address (Main Office and Branch where worked):


3rd Floor, Cambata Building, Above Eros Theatre, Jamshedji Tata Road, Churchgate, Mumbai – 400020.
www.integrityvs.com

Company Board Line Numbers (No


Cell Phone numbers accepted)
If Deputed by Agency - Agency name
and address

Tel no of the Agency


Employee Code
Designation and Dept
Date of Joining
Date of Leaving
Monthly Gross Salary
Reasons For leaving
Supervisor’s Name and Designation

Supervisor’s Official Mail ID

Supervisor's direct Line Number and


Mobile no.

Any other information you would like to provide:

Attention:
 Please provide the Employee Code mandatorily and clearly
 Please provide a copy of the last Salary Slip of your Current Employer
 Please provide a copy of your Relieving Letter / Service Certificate for Employment
mentioned above

PROFESSIONAL REFERENCE 1

Reference Name :

Reference Relationship with the Candidate


3rd Floor, Cambata Building, Above Eros Theatre, Jamshedji Tata Road, Churchgate, Mumbai – 400020.
www.integrityvs.com

Reference Email ID:

Reference Mobile No:

Any other information you would like to provide:

PROFESSIONAL REFERENCE 2

Reference Name :

Reference Relationship with the Candidate:

Reference Email ID:

Reference Mobile No:

Any other information you would like to provide:

Letter of Authorization

To whom it may concern

I hereby authorize Integrity Verification Service Private Limited and any of its
representatives (IVS) to verify all the information provided in my application of
employment and to conduct such enquiries as may be required by IVS to verify facts of
3rd Floor, Cambata Building, Above Eros Theatre, Jamshedji Tata Road, Churchgate, Mumbai – 400020.
www.integrityvs.com

such information provided by me. I hereby declare that this authorization shall be valid till
such time I remain an employee IVS

I hereby authorize all individuals, Private Establishments, Government


establishments/Agencies, Educational institutions who may have information relevant to
this enquiry to co-operate to IVS and/or its representatives such information as may be
required. I hereby release IVS, all its personnel and representatives from any liability
which could result, either directly or indirectly, from the disclosure of information by a third
party to another party in response to such enquiries.

Signature:

Name in Block Capitals

Date:

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