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Background Verification Form

This document is a background verification form that collects personal and employment information. It requests details such as name, date of birth, addresses, contact information, education history, and references. The form is to be filled in block letters without abbreviations with fields marked with asterisks being mandatory.

Uploaded by

Nikitha Reddy
Copyright
© © All Rights Reserved
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
66 views

Background Verification Form

This document is a background verification form that collects personal and employment information. It requests details such as name, date of birth, addresses, contact information, education history, and references. The form is to be filled in block letters without abbreviations with fields marked with asterisks being mandatory.

Uploaded by

Nikitha Reddy
Copyright
© © All Rights Reserved
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Background Verification Form

Instructions: Please fill the form in BLOCK letters only and do not use any abbreviations
Fields Marked in (*) is mandatory.

Personal Information
*First Name NIKHITHA
*Middle Name
*Last Name K
Former/Maiden Name
*Nationality Indian
*Gender Male Female
*Marital Status SingleMarried Others: ____________
*Date of Birth 0 9 1 2 2 0 2 1
*Father’s Name K PATTABHI REDDY
*Personal Landline No *Personal Mobile No. 8008359558
*Identification Type * Identification No.
(Passport / PAN Card / Driving (Passport / PAN Card / Driving
AADHAR License / Voter’s Card / Aadhaar
403882922259
License / Voter’s Card / Aadhaar
Card) Card)

National Identity No./


Social Security No.
(If Applicable for Overseas
location)

CurrentAddress
*House/Flat Number 109
*Building Number & Name HELLO WORLD BLISS
Address Line 1 KARAPAKKAM
Address Line 2
Address Line 3
*City CHENNAI *Postal/Zip Code 600097
*State TAMILNADU *Country India
*Prominent Landmark
*Period of From 0 8 1 0 2 0 2 1

Stay To 0 1 0 1 2 0 2 3

*Landline Number
*Mobile Number 8008359558

Confidential
Permanent Address
Same As Above YES NO
*House/Flat Number
*Building Number & Name
Address Line 1
Address Line 2
Address Line 3
*City *Postal Code
*State *Country India
*Prominent Landmark
*Period of From D D M M Y Y Y Y

Stay To D D M M Y Y Y Y

*Landline Number
*Mobile Number

Education Section
Instructions: Fields Marked in (*) is mandatory.

HIGHEST - Qualification
*Name of Qualification Obtained B.COM
* School/ College/Institute - Name VIJAYAM DEGREE COLLEGE
*School/ College/Institute - Location CHITTOOR
School/ College/Institute - Contact No 8247280713
*University / Board - Name SV UNIVERSITY
*University / Board - Location TIRUPATI
Enrolment / Roll / Registration
0218048175
Number
0 6 1 8
From
*Period of Study 0 6 2 1
To
*Year of Passing *Graduated Yes No Pursuing
*Course Attended Regular / Full Time Part TimeCorrespondence
Final Year Mark-sheet Degree Certificate (Along with backside if any)

*Documents Submitted Provisional Certificate Consolidated Mark sheet

Other -: ________________

Confidential
Reference Section
Instructions: Fields Marked in (*) is mandatory.

Details Reference 1 Reference 2


*Name GOWRI
*Designation AUDITOR
*Organization ADP
*Relationship MAM
* Contact No. 9790898951
*Email ID [email protected]

Confidential

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