BACKGROUND VERIFICATION FORM

Globallogic Technologies Pvt. Ltd

FILL THIS FORM CLEARLY, CORRECTLY AND IN CAPITALS ONLY
Personal Information
Full Name (Expand Initials) Former Name / Maiden Name
(Applicable only for married females)

Father's Name Date of Birth (DD/MM/YY)

Gender Social Security Number (if applicable) Nationality Marital Status

Male Passport No.
Driving License No.
Female PAN Card No.
Current Address Period of From (MM/YY) To (MM/YY) Residence Phone Nu
(Mention Full Address with Pincode & Landmark) stay
Full Name:
C/o,S/o,D/o:
Door No:
Street: Mobile number
City/District:
State:
Pincode:
Prominent Landmark

Permanent Address
(Mention Full Address with Pincode & Landmark) Period of From (MM/YY) To (MM/YY) Residence Phone Nu
Full Name: stay
C/o,S/o,D/o:
Door No:
Street:
City/District: Mobile number
State:
Pincode:
Prominent Landmark

Address History (List most recent first) - Mandatorily provide complete addresses for the last TWO YEARS
Period of Stay Mention Full Address
From (MM/YY) To (MM/YY) with Landmarks

C/o,S/o,D/o:
Door No:
Street:
City/District:
State:
Pincode:
Landmarks:

C/o,S/o,D/o:
Door No:
Street:
City/District:
State:
 Pincode:
Landmarks:

Education Qualification - Mandatorily & Correctly provide complete details of SSC & Highest Degree
Course / Qualification Name College Name & Address Dates Attended University / Board
From To Name & Address
SSC MM/YY MM/YY

Full Time
Part Time
Highest Degree (Mention Degree) MM/YY MM/YY

Full Time
Part Time
Employment History (All fields are Mandatory)

Note: Give descriptive information where ever necessary – e.g. If the current/previous company is closed, do mention it unde
Leaving". Employee Code/ ID is mandatory. Incase you dont have an EMP ID/No., mention the same under respective field.
Current Employer - Please attach a copy of your Offer letter, Pay Slips, Increment letters
Name of Current Employer Address of Current Employer

Board No./HR Dept No. Employee Code/ID Designation Department

Employment Period Manager's Name Manager's Contact No

From To
Manager's Email ID

Duties & Responsibilities Reasons for leaving

First Salary (Gross Per Month) Is this Position Agency Details (if temporary or contractual), provide detail
Permanent
Last Salary (Gross Per Month) Temporary
Contractual
Please tick mark the documents submitted for this employment
Offer Letter Experience Letter Relieving Letter Pay Slips

Previous Employer 1 - Please attach a copy of your relieving letter or experience letter
Name of Previous Employer (1) Address of Employer

Board No./HR Dept No. Employee Code/ID Designation Department

Employment Period Manager's Name Manager's Contact No

From To
Manager's Email ID

Duties & Responsibilities Reasons for leaving

First Salary (Gross Per Month) Was this Position Agency Details (if temporary or contractual), provide detail
Permanent
Last Salary (Gross Per Month) Temporary
Contractual
Please tick mark the documents submitted for this employment
Offer Letter Experience Letter Relieving Letter Pay Slips

Previous Employer 2 - Please attach a copy of your relieving letter or experience letter
Name of Previous Employer (2) Address of Employer

Board No./HR Dept No. Employee Code/ID Designation Department

 Employment Period Manager's Name Manager's Contact No
From To
Manager's Email ID

Duties & Responsibilities Reasons for leaving

First Salary (Gross Per Month) Was this Position Agency Details (if temporary or contractual), provide detail
Permanent
Last Salary (Gross Per Month) Temporary
Contractual
Please tick mark the documents submitted for this employment
Offer Letter Experience Letter Relieving Letter Pay Slips
Reference Details: Provide details of both professional and personal references

Professional Reference: To be filled if you are currently working or experienced

Name, Company & Designation:
Current Address:

Contact No:

How do you know this person?

Personal Reference: Mention about any one of your friends or family members
Name & Occupation:
Current Address:

Contact No:

How do you know this person?

Please mention about GAPS during Education or Employment - MANDATORY (If there were NO GAPS, just leave it blank)

From (MM/YY) To Reason for Gap:

(MM/YY)

Complete Address and Location during gap:

From (MM/YY) To Reason for Gap:

(MM/YY)

Complete Address and Location during gap:

From (MM/YY) To Reason for Gap:

(MM/YY)

Complete Address and Location during gap:

Declaration and Authorization

I hereby authorize Gloabllogic technologies Pvt. Ltd.(or a third party agent appointed by the Company) to contact any former employer
and carry out all Background Checks not restricted to education and employment deemed appropriate through this selection procedure
employers, agencies, educational institutes etc. to release any information pertaining to my employment/education and I release them
doing so.

I confirm that the above information is correct to the best of my knowledge and I understand that any misrepresentation of information
form may, in the event of my obtaining employment, result in action based on company policy.
I confirm that the above information is correct to the best of my knowledge and I understand that any misrepresentation of information
form may, in the event of my obtaining employment, result in action based on company policy.

Signature:

Full Name: Date:

RM

females)

Status

nce Phone Number

number

nce Phone Number

number

ARS
Contact Number
Degree
ersity / Board ID /Roll No
e & Address
ention it under "Reasons for
ctive field.

ment

Can the check be done now?

Yes
No

provide details

None

ment

ct No

provide details

None

ment
ct No

provide details

None
 it blank)

mer employers as indicated above

tion procedure. I authorize former
release them from any liability in

of information on this application