Candidate Information Form (CIF) – Excelity Global

Instructions: Please provide all the information requested in this form. Incomplete Candidate Information Forms will be returned for
completion. All supporting documents must accompany this form. Legible photocopies are requested please.

PERSONAL DETAILS (PART A):

Father’s Name: ________________________

Date of birth (DD/MM/YY): _____________ Nationality: ___________ ________________

You’re Phone Number (Land Line and/or Mobile): _________________________ _______________

Social Security Number (If worked/studied in the US/Any other Country):

Change of Name if Applicable

Former Name/Maiden Name: ____________________________

Date of Name Change: _____________________

Current Address (Please provide detailed/complete address)

Door No/House name: Street: ______________________

City: __________________State: __________________ PIN_______ ___

Landmark: ________________________________ : (Landline)

Permanent Address (Please provide detailed/complete address)

Door No/House name: Street: ______________________

City: __________________State: __________________ PIN_______ ___

Landmark: ________________________________ : (Landline)

Note: Please attach a legible copy of any one of following documents:

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PART B - EDUCATION DETAILS

Highest Education Completed

Board/University: Division/Class/%:

Duration of Study: From (_ _ _ /_ _ _ _) to (_ _ _ /_ _ _ _) - MMM/YYYY Degree Obtained:

Subject: Course Type: Regular [ ] Distance [ ]

Student ID/Enrolment/Registration/Roll No:

Building No & Street:

Address of Institute/School/College City: State:

Pin: Landline:

Note: Please attach legible photo copies of the following documents relevant to the entries above.
1) All Mark sheets 2) Degree Certificate 3) Provisional Degree Certificate

PART C - PREVIOUS EMPLOYMENT DETAILS

Employment - 1
Name of Company:
Building No & Street:
Company Address
City: State:
(Where you were employed)
Pin:  (Landline):
Period of employment: From (_ _/_ _ _ /_ _ _ _) to (_ _/_ _ _ /_ _ _ _)– DD/MMM/YYYY Employee ID:
Designation & Department: Last Drawn Salary (CTC):

Type of Employment: Permanent [ ] Contractual [ ] Part time [ ] Full Time [ ]

Supervisor’s Name & Designation: Supervisor’s Direct Number & Mail Id:

Can the employer be contacted now? [ ] Yes [ ] No

If not, then provide an alternate date:

Reason for Leaving:

Note: Please attach legible photo copies of the following documents relevant to the entries above.
1) Appointment Letter 2) Salary Slip 3) Relieving Letter 3) Service/Experience Letter

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 Employment – 2
Name of Company:
Building No & Street:
Company Address
City: State:
(Where you were employed)
Pin:  (Landline):
Period of employment: From (_ _/_ _ _ /_ _ _ _) to (_ _/_ _ _ /_ _ _ _)– DD/MMM/YYYY Employee ID:
Designation & Department: Last Drawn Salary (CTC):

Type of Employment: Permanent [ ] Contractual [ ] Part time [ ] Full Time [ ]

Supervisor’s Name & Designation: Supervisor’s Direct Number & Mail Id:

Can the employer be contacted now? [ ] Yes [ ] No

If not, then provide an alternate date:

Reason for Leaving:

Note: Please attach legible photo copies of the following documents relevant to the entries above.
1) Appointment Letter 2) Salary Slip 3) Relieving Letter 3) Service/Experience Letter

Employment - 3
Name of Company:
Building No & Street:
Company Address
City: State:
(Where you were employed)
Pin:  (Landline):
Period of employment: From (_ _/_ _ _ /_ _ _ _) to (_ _/_ _ _ /_ _ _ _)– DD/MMM/YYYY Employee ID:
Designation & Department: Last Drawn Salary (CTC):

Type of Employment: Permanent [ ] Contractual [ ] Part time [ ] Full Time [ ]

Supervisor’s Name & Designation: Supervisor’s Direct Number & Mail Id:

Can the employer be contacted now? [ ] Yes [ ] No

If not, then provide an alternate date:

Reason for Leaving:

Note: Please attach legible photo copies of the following documents relevant to the entries above.
1) Appointment Letter 2) Salary Slip 3) Relieving Letter 3) Service/Experience Letter

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 Employment - 4
Name of Company:
Building No & Street:
Company Address
City: State:
(Where you were employed)
Pin:  (Landline):
Period of employment: From (_ _/_ _ _ /_ _ _ _) to (_ _/_ _ _ /_ _ _ _) – DD/MMM/YYYY Employee ID:
Designation & Department: Last Drawn Salary (CTC):

Type of Employment: Permanent [ ] Contractual [ ] Part time [ ] Full Time [ ]

Supervisor’s Name & Designation: Supervisor’s Direct Number & Mail Id:

Can the employer be contacted now? [ ] Yes [ ] No

If not, then provide an alternate date:

Reason for Leaving:

Note: Please attach legible photo copies of the following documents relevant to the entries above.
1) Appointment Letter 2) Salary Slip 3) Relieving Letter 3) Service/Experience Letter

Employment - 5
Name of Company:
Building No & Street:
Company Address
City: State:
(Where you were employed)
Pin:  (Landline):
Period of employment: From (_ _/_ _ _ /_ _ _ _) to (_ _/_ _ _ /_ _ _ _) – DD/MMM/YYYY Employee ID:
Designation & Department: Last Drawn Salary (CTC):

Type of Employment: Permanent [ ] Contractual [ ] Part time [ ] Full Time [ ]

Supervisor’s Name & Designation: Supervisor’s Direct Number & Mail Id:

Can the employer be contacted now? [ ] Yes [ ] No

If not, then provide an alternate date:

Reason for Leaving:

Note: Please attach legible photo copies of the following documents relevant to the entries above.
1) Appointment Letter 2) Salary Slip 3) Relieving Letter 3) Service/Experience Letter

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MISCELLANEOUS (PART E) - Please tick the appropriate answers.
Have you ever been convicted or accused of a felony or any serious crime?
 Yes
 No

If the answer is ‘Yes’, please provide details below:

Have you ever been ‘Laid off’ or ‘Terminated’ from employment?

If the answer is ‘Yes’ please provide details below:

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 Authorization Letter
To whomsoever it may concern

I hereby authorize Excelity Global to verify my background credentials from Footprints Collateral Services Pvt. Ltd. which
includes my current/previous Employment history, Educational/Professional Credentials and my Criminal/Address background
check.

Footprints Collateral Services Pvt. Ltd. may obtain appropriate information from different sources as per the details
mentioned in my application form submitted to my Employer, which includes Employment history from my current/previous
employer. Educational/Professional Credentials to be checked from School/College/University/Autonomous institute and my
Criminal/Address background check from Civil/Credit violations records.

Footprints Collateral Services Pvt. Ltd. reserve the rights to obtain appropriate information from any individual, corporation
or any confidential information deemed necessary to check my credentials and furnish the same to my employer.

I unconditionally release all concerned parties from all liabilities that might arise as a result of my background verification
check and also do not hold responsible, any individual, corporation or private and public entity as a consequence of this
check.

I also authorize release of this information in original, fax or photocopy form as deemed necessary and authenticate the
validity of the same.

Name of the Candidate :

Date :

Signature of the Candidate :

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