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EMPLOYMENT VERIFICATION FORM

Instructions:
- Provide complete and correct information
- The information provided should match with the resume submitted
- All fields are mandatory
- Do not use short forms/Abbreviations
- Use uppercase letters when filling the forms
The background check will cover:

o 3 yrs experience
o Required Documents (all):
Service Certificate or Relieving Letter
Latest Salary Slip
If your previous employer is closed, we need
Form 16 or
Bank statement that specifies the company name
against the deposit
Highest Academic educational details
o Required Documents (all)
Degree certificate
Final year mark sheets

PERSONAL DETAILS
Title (Mr./Mrs./Ms.)
Name (Last)

(First)

(Middle)

Fathers Name:
Nationality
Date of Birth
(yyyy/mm/dd)
Gender:
Male
Female

Marital Status:

Married
Unmarried

Maiden Name (applicable for married ladies):

Mandatory ONLY for Criminal Check Process

CONTACT DETAILS
Permanent Residential Address
(Number and Street)
Period of Stay

From

To

From

To

From

To

Intermediate Residential Address


(Number and Street)
Period of Stay
Current Residential Address
(Number and Street)
Period of Stay
Nearest Police Station:
Contact Telephone No. (Specify
Location Codes)

Office
Telephone
No.

Mobile/Pager Email
Address

Current

Intermediate Permanent

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
(Month/yr)

To (Month/Yr) Graduated Program %/


Class
Yes
No

Type of Degree
certificate,

Graduation
Date
(month/yr)

Copy of Certificate Attached

Parttime
FullTime
Subject Major

Yes

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

No

Student Id
No./Enrolment
No.

EMPLOYMENT SECTION: Please give the details of your previous


employments. Please provide
-

telephone numbers with the location code


your employee id/code/number with each previous employer
please provide following documents:
o form 16 or
o Bank statement that specifies the company name against the
deposit

Please ensure that your details here match with the resume that you
submitted

How many years have you worked? ____________________


How many employers have you worked for (including your current
employer)? ___________________________

EMPLOYMENT 1 (Current/Most recent)


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


where worked)

Company
Telephone:

Employment Period (dd/mm/yyyy)

Reported to
(Name &
Position):

DOJ :

Name of HR
Manager

DOR :
Whether employment is of permanent or temporary nature
Permanent

Temporary

Contract

Emp Code/Personnel No:

Social Security Number (Mandatory if worked in USA):


Responsibilities:
Last Monthly Gross Salary
(Please attach the self-attested copy
of your last pay slip.)

Can a verification be done now?


If No, when can it be done?

Reasons for Leaving

Yes

No

EMPLOYMENT 2 (prior to the current/latest employment)


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


where worked)

Company
Telephone:

Employment Period (dd/mm/yyyy)


DOJ

Reported to
(Name &
Position):

Name of HR
Manager

DOR
Whether employment is of permanent or temporary nature
Permanent

Temporary

Contract

Emp 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 a verification be done now?


If No, When can it be done?

Yes

No

EMPLOYMENT 3 (prior to employment 2)


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


where worked)

Company
Telephone:

Employment Period (dd/mm/yyyy)

Reported to
(Name &
Position):

DOJ :

Name of HR
Manager

DOR :
Whether employment is of permanent or temporary nature
Permanent

Temporary

contract

Emp 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 a verification be done now?


If No, When can it be done?

Yes

No

Declaration
I hereby certify all of the statements made on the PRIMUS Global
Technologies Pvt. Ltd 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 PRIMUS Global
Technologies Pvt. Ltd. I may be the subject of a background enquiry by
PRIMUS Global Technologies Pvt. Ltd or its representative and I hereby
authorize the same.
Signature

Name in Capital

Date

Letter of Authorization

To whom it may concern


I hereby authorize PRIMUS Global Technologies Pvt. Ltd representative to
verify information provided in my resume and application of employment
and to conduct enquiries as may be necessary at the companys discretion.
I authorize all persons who may have information relevant to this enquiry to
disclose it to PRIMUS Global Technologies Pvt. Ltd or its representative. I
realize all persons from liability on account of such disclosure.
Signature

Name in Capital

Date