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Consent and Indemnity Form Template

This document is a Consent and Indemnity Form for candidate Nosipho Langa, who is applying for a position with Professional Career Services. It includes personal information, verification checks, and authorizations for background checks by LexisNexis Risk Management. The candidate acknowledges the terms and conditions regarding the use of their personal information in the employment vetting process.

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nosipholanga79
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91 views2 pages

Consent and Indemnity Form Template

This document is a Consent and Indemnity Form for candidate Nosipho Langa, who is applying for a position with Professional Career Services. It includes personal information, verification checks, and authorizations for background checks by LexisNexis Risk Management. The candidate acknowledges the terms and conditions regarding the use of their personal information in the employment vetting process.

Uploaded by

nosipholanga79
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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Consent and Indemnity Form


Company Name: Professional Career Services Consultant Name: Zimkhitha
Email address: pcscandidates@[Link] Phone Number: 011 789 3337

Candidate Information
Surname: Langa Full First Name: Nosipho

Maiden Surname: Langa Date of birth: 04 July 1992


SA ID number: 9 2 0 7 0 4 0 4 2 6 0 8 4 Passport:

Physical Address: 310 Castlehill Drive, Newlands West, Durban

Verifications
 Criminal Record Have you ever had a previous conviction YES NO ✔️
If yes, detail of conviction

 Credit Checks
1. Employment, “considering candidate for employment in a position that requires honesty in dealing with cash
and finances” as per relevant job description x
2. Verifying educational qualifications and employment x
3. Fraud detection and fraud prevention services x

 Fit and Proper Check (FSB and RE Examination) x


 Academic Qualification x
Year
Qualification Institution City Student No.
Completed
Hospitality Management International Hotel School Incomplete
4000509
National Senior Certificate (Matric) Ridge Park College

Indemnity
I hereby authorize The Company / The Company’s duly authorized verification agent, LexisNexis Risk Management “LNRM”, to
forward my personal information, including but not limited to my name, surname, identity number and fingerprints, to
verification suppliers acting on behalf of LNRM (including but not limited to SAPS, the Government of RSA, any educational,
training, credit bureau and fraud prevention organisation).

I authorize LNRM to conduct all verification checks (including but not limited to credit bureau searches, drivers licenses,
employment history, employment salary verification and any other relevant checks in the pre- and post – employment vetting
process).

I authorize LNRM suppliers to furnish personal information regarding my credentials, whether claimed or not, to LNRM and The
Company. I unconditionally indemnify LNRM and its verification information suppliers against any liability which results or may
result from furnishing information in this regard.

I understand that it is a condition of the South African Police Service and Tertiary Education Institutions, that –

 The information furnished to The Company and LNRM will be disclosed to me for comment before a decision is made
on my employment / application; and
 The Company is responsible for verifying the accuracy in respect of information furnished to the South African Police
Service
Signed at Durban (place) on 18 /11 /2025 (date)

Applicant Signature: Nosipho Langa Consultant Signature:

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