employment

is contingent
successful
background
completion
check.
of upon
this
FORM
BACKGROUND CHECK
Guidelines/Check List

Your Job Offer is subject to successful completion of Background Verification.

Fill-Up this form accurately by attaching all necessary documents (ANNEXURE 1) as
proof.
Ensure consistency in the information provided by you in the form.
No Form will be accepted if any of the necessary documents are missing.

FULL NAME:
(As per 10th certificate)

DOB:(YYYY-MM-DD)

(Attach Proof)
Permanent Address:
(Attach Proof)

Land Mark:

State

Present Address:

Guardian/Fathers Name:

Occupation:

Mothers Name:

Occupation:

Email Id:

Mobile No:

Nationality:

Marital Status:

Alternative No:

Pin code:

Education Details
Course
(Attach Proof)

University/Institution/College Name

Duration

Post-Graduation:
(If Any)
Graduation
(Discipline):
Class XII (Stream)

Experience Details (If Any)

Company Name
(Attach Proof)

Designation

Domain

Duration

GAP Duration Details (If Any):

GAP Duration:

Reasons/Details:

References (No Relatives to be mentioned)

Name (Title & Designation)

Relation with you

Contact Details
(Phone no. & email id)

Passport (Attach Proof)

Passport Number

PAN Number (Attach Proof):

Name as in Passport:

Validity (Expiry Date)

DECLARATION FOR BACKGROUND FORM

Golden Hills as referenced in this application, is intended to refer to the
Golden Hills Capital India Private Limited.
I understand that I must provide satisfactory documentation of my
authorization to work in India as a condition of employment with Golden
Hills.
Golden Hills is an Equal Opportunity Employer: Hiring and employment
decisions are made without regard to race, color, religion, sex, national
origin, age, disability, citizenship, veteran, status, or any other
characteristics protected by law.
I agree to provide copies of all relevant certificates and documentation
requested.
I understand and agree that any employment or offer of employment is
subject to receipt of satisfactory references concerning employment and
educational history, a satisfactory background check and submission of
required documentation for personal records.
I understand that convictions for various crimes may restrict my eligibility
for employment.
I understand that if I am aware of any medical issue which may interfere
with my ability to complete this process or with the performance of my
duties, I should make my recruiter aware of this.
I certify that the information furnished on this application and during the
application process is true, complete and correct and understand that I
am liable for inaccuracies and omissions.
I understand and agree that any misstatement, misrepresentation, or
omission of facts on this form or on a resume will constitute grounds for
refusal to hire, rescission of an offer of employment, or disciplinary action
up to and including termination, regardless of when such misstatement,
misrepresentation, or omission is discovered.
I authorize Golden Hills and its representative, now and during my
employment, to authenticate information I have provided my CV/resume
and this form, including but not limited to academics, residential,
achievement, job performance, attendance, litigation, personal history,
credit reports, driving records, and criminal history information.
Additionally, I authorize all who may have information relevant to this
enquiry to disclose it to Golden Hills and/ or its representative. I release
all concerned from any liability on account of such disclosures.
I HAVE READ, I UNDERSTAND, AND I AGREE TO THE ABOVE.
Full Name:
Signature:

Place:
Date:

ANNEXURE I
Please provide the following documents for company records:
1. Photo Two passport sized photograph of yourself
2. Educationa) 10th Mark Sheet
b) 12th / Diploma Mark Sheet
c) Graduation Mark Sheets (all semesters/years)
d) Graduation / Convocation or Provisional Degree Certificate
e) Post-Graduate Mark Sheets(all semesters/years) If applicable
f) Post-Graduate /Convocation or Provisional Certificate- if applicable
3. Identity Proofs
a) PAN Card or Acknowledgement copy of the application
b) Any government ID proof such as valid Passport Copy, Drivers License,
Aadhar Card OR Voters ID
4. Address Proofs
a) Any government address proof such as valid Passport Copy, Drivers
License, Aadhar card OR Voters ID.
b) Electricity Bill or Rental Agreement.
5. Previous Employment for each employment experience listed:
a) Appointment/Joining Letter issued
b) Last 3 months Salary Slips of previous company
c) Relieving Letter of previous 2 companies(if any)
Note: All the documents needs to be self-attested.