Britannia Background Check Form

Published on June 2016 | Categories: Types, Brochures | Downloads: 216 | Comments: 0 | Views: 503
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Verifacts

Background Verification Form - Britannia Instructions: Please provide required information requested in this form. All supporting documents must accompany this form. Photocopies must be legible. PERSONAL INFORMATION First Name: __________________Middle Name: __________________ Last Name: ______________ Employee ID: __________ Location: ___ _____ Fathers Name: _________________________________________________
(Expand the initials)

Please Affix Recent Passport Sized photograph

Date of birth (DD/MM/YY): ________ Nationality: ___________ Proof of DOB (please enclose Birth Certificate or 10th Mark sheet or Passport Copy)

Change of Name if Applicable Former Name/Maiden Name _____________________________ ________________________________ Date of Name Change ___________________________

For Internal Use Only Candidate Reference No: ___________________

1

Verifacts ADDRESS DETAILS
Note: Please attach legible Photo copies of the following, relevant to the entries. Proof of Address: (Photocopy of Passport, Voters ID, Ration Card, Rent agreement & Utilities bill )

Current Address Door No / Street: City: State: Pin: Landmark: Landline / Mobile: Period of Stay:
(Please Write Start Date or start Month to Till date )

Is your current residence owned or a rented place? If rented, please provide details of the Landlord If above current address is less than 6 months please provide previous address details Previous Address Details-1 Door No / Street: City: State: Pin: Landmark: Period of Stay:
Please Write Start Date or start Month to End date )

Contact Details

Name: Address: Land Line/Mobile No

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Permanent Address Door No / Street: City: State: Pin: Landmark: Landline / Mobile: Period of Stay: Is your residence your own or a rented place? If rented, please provide details of the Landlord

Note: Please attach legible Photo copies of the following, relevant to the entries. Proof of Address: (Photocopy of Passport, Voters ID, Ration Card, Rent agreement & Utilities bill )

3

Verifacts EDUCATION DETAILS

Have you obtained your educational qualification (Graduation / Highest Level of Educational Qualification outside India? Yes/No--- No
Education (Graduation) Name of College/Study Centre Name of Board / University Address of College/Study Centre Student ID No:/ Enrolment No Division / Class Subject Major
Note: Please Enclose legible Photo Copies of the following documents relevant to the entries above 1) Mark sheets of all semesters/years 2) Degree Certificates, FRONT and BACK or Provisional Certificate 3) Initial two and lat one page of Passport Copy

4

Verifacts Highest Education-1 (Post Graduation Or professional Degree) Name of College/Study Centre Name of Board / University Address of College/Study Centre Student ID No:/ Enrolment No Division / Class Subject Major

Note: Please Enclose legible Photo Copies of the following documents relevant to the entries above 1) Mark sheets of all semesters/years 2) Degree Certificates, FRONT and BACK or Provisional Certificate 3) Initial two and lat one page of Passport Copy

Highest Education-2 (Post Graduation Or professional Degree/PhD etc) Name of College/Study Centre Name of Board / University Address of College/Study Centre City: Pin: * : (Email ID) State: (: (Landline) Period of Study Degree Obtained Course Type (Regular/Distance

Student ID No:/ Enrolment No Division / Class Subject Major

Note: Please Enclose legible Photo Copies of the following documents relevant to the entries above 1) Mark sheets of all semesters/years 2) Degree Certificates, FRONT and BACK or Provisional Certificate 3) Initial two and lat one page of Passport Copy

5

Verifacts

EMPLOYMENT DETAILS
Note: Please furnish last 2 employment details.

Employment -1
PERMANENT EMPLOYMENT Name of Company Where were you employed? Company Address (Where were you employed )
Period of employment (Start & End Date) Designation and Department Supervisor’s (Reporting Manager) Name and Designation Remuneration (Phone No (Email Id (Phone No. (Email Id 

Registered Corporate Office



Branch Office

( (Contact Details)
Employee Code

HR contact details (Name and Designation) Reason for leaving Can a reference be taken now? If No, when can it be taken? o Yes

o

No

CONTRACTUAL EMPLOYMENT
Name of Company & Address

* (Email Id) Designation: Employee Code

( (Landline) Period of employment (Start & End Date) Reason for leaving * (Email Id)

Company Contact Person ( (Landline)

Note: Please attach legible Photo copies of the following documents relevant to the entries above 1) Appointment Letter 2) Release Letter or service certificate 3) Pay Slips.

Previous Employment - 2
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Verifacts
PERMANENT EMPLOYMENT
Name of Company Where were you employed? Company Address (Where were you employed ) Period of employment (Start & End Date) Designation and Department Supervisor’s (Reporting Manager) Name and Designation Remuneration (Phone No (Email Id (Phone No. (Email Id ( (Contact Details) Employee Code  Registered Corporate Office  Branch Office

HR contact details (Name and Designation) Reason for leaving Can a reference be taken now? If No, when can it be taken? o Yes

o

No

CONTRACTUAL EMPLOYMENT
Name of Company & Address

* (Email Id) Designation: Employee Code

( (Landline) Period of employment (Start & End Date) Reason for leaving * (Email Id)

Company Contact Person ( (Landline)

Note: Please attach legible Photo copies of the following documents relevant to the entries above 1) Appointment Letter 2) Release Letter or service certificate 3) Pay Slips.

7

Verifacts Professional References: Ref 1:
Name

Company/Designa tion Landline Ref 2:
Name

Mobile

E-mail Id

Company/Designa tion Landline Mobile E-mail Id

Ref 3:
Name

Company/Designa tion Landline Ref 4:
Name

Mobile

E-mail Id

Company/Designa tion Landline Mobile E-mail Id

8

Verifacts

Letter of Authorization To whom it may concern I understand that Britannia may use an outside agency to verify and validate the information I have provided as a part of my employment application, including my employment, my personal background, professional standing, work history and qualifications. I authorize, without reservation, any individual, corporation or other private or public entity to furnish Britannia. 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 Britannia 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. I also authorize, without reservation, Britannia to share the details obtained by these checks, whether fully or in part, with third parties (including, without reservation, with statutory bodies, customers or vendors), Infosys will exercise due care while sharing these details.

Name: ______________________________ Employee Number: _____________________ Signature: _____________________________ Date: _______

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I hereby certify that all information provided herein, is true and complete to the best of my knowledge an belief. I authorize Britannia and its representative to authenticate information I have provided in this BG Verification form. To conduct enquiries as may be necessary at the company’s discretion, I authorize a who may have information relevant to this enquiry to disclose it Britannia and/or its representative. release all concerned from any liability on account of such disclosures.

I also declare that the information provided by me in this application for employment to Britannia and i representative is authentic and I am liable for all inaccuracies and omissions. I promise to extend total co-operation and provide relevant documents required.

Full Name of the Candidate: ___________________________________ Candidate

Signature of the

Place: ____________________________________________________ Date: _____________________________________________________

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Verifacts

Documents to be furnished by the candidate for verification Employment verification: 1. Relieving Letter with employee code duly signed by the authorized official. 2. Service certificate with employee code duly signed by the authorized official. 3. Salary slips Address verification:
1. 2. 3. 4. Photocopy of Passport Voters ID Ration Card Rent agreement Utilities bill.

5.

Note: All the documents should have candidates name on it. • • Clear Background Verification form with all the necessary components duly filled by the candidate. Letter of Authorization duly signed by the candidate along with date is mandatory.

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