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 SYED
*Middle Name SUMBUL
*Last Name SUHAIL
Please affix
Former/Maiden Name your most
recent photo
*Nationality INDIAN here
*Gender Male Female ✅
✅ Single Married Others :
*Marital Status
____________
*Date of Birth 1 4 0 5 1 9 9 5

*Father’s Name SYED SUHAIL AHMAD LT

*Personal Landline No *Personal Mobile No. 7985542654
*Identification Type * Identification No.
(Passport / PAN Card / Driving (Passport / PAN Card / Driving
Aadhaar Card License / Voter’s Card / Aadhaar
665116567235
License / Voter’s Card / Aadhaar
Card) Card)

National Identity No./

Social Security No.
(If Applicable for Overseas
location)

Current Address
*House / Flat Number 13/1
*Building Number & Name FORT BAJAR
Address Line 1 Out side syed gate Jhanshi
Address Line 2
Address Line 3
*City VEERANGA LAXMI BAI *Postal/ Zip Code 284001
*State UTTAR PRADESH *Country INDIA
*Prominent Landmark NEAR DAU SAMOSE WALA
*Period of From 0 1 0 1 1 9 9 2

Stay To 1 1 0 9 2 0 2 2

*Landline Number 8382055854

*Mobile Number 7985542654

Permanent Address
Same As Above YES NO
*House / Flat Number 13/1

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*Building Number & Name FORT BAJAR
Address Line 1 Out side syed gate Jhanshi
Address Line 2
Address Line 3
*City *Postal Code
*State *Country
*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

Previous Addresses

*City *Postal Code

Address 1 *Prominent Landmark

*State *Country

*Contact No. of current

*Period of Stay From Date To Date
tenant / Landlord

*City *Postal Code

Address 2 *Prominent Landmark

*State *Country

*Contact No. of current

*Period of Stay From Date To Date
tenant / Landlord

*City *Postal Code

Address 3 *Prominent Landmark

*State *Country

*Contact No. of current

*Period of Stay From Date To Date
tenant / Landlord

Address 4

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 *City *Postal Code

*Prominent Landmark

*State *Country

*Contact No. of current

*Period of Stay From Date To Date
tenant / Landlord

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

HIGHEST - Qualification 1
*Name of Qualification Obtained
* School/ College/Institute - Name MBA
*School/ College/Institute - Location GWALIOR
School/ College/Institute - Contact No 474020
*University / Board - Name JAIWAJI UNIVERSITY
*University / Board - Location GWALIOR
Enrolment / Roll / Registration Number
0 8 1 5
From
*Period of Study 0 6 1 7
To
*Graduated ✅ Yes No Pursuing
*Year of Passing 2017

*Course Attended Regular / Full Time Part Time Correspondence

Final Year Mark-sheet Degree Certificate (Along with backside if any)

*Documents Submitted Provisional Certificate Consolidated Marksheet

Other -: ________________

Qualification 2
*Name of Qualification Obtained
* School/ College/Institute - Name
*School/ College/Institute - Location
School/ College/Institute - Contact No
*University / Board - Name
*University / Board - Location
Enrolment / Roll / Registration Number
M M Y Y
From
*Period of Study M M Y Y
To
*Year of Passing *Graduated Yes No Pursuing
*Course Attended Regular / Full Time Part Time Correspondence
*Documents Submitted Final Year Mark-sheet Degree Certificate (Along with backside if any)

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Provisional Certificate Consolidated Marksheet

Other -: ________________

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Employment Section
Note: Please start with your most recent employer
Instructions: Fields Marked in (*) is mandatory.

Current Employer 1
*Company Name TELEPERFORMANCE
Company/Operation Closed Functional Re-located
Company Current Status
Merged with

Company also Known as

*Complete Company
Address with Landmark BHAWANA PLAZZA
(Where candidate has worked)

* Company Contact No.

*City Agra *State
*Supervisor Name and SIFA KHAN AND
*Designation QUALITY ANALYST Designation QUALITY TEAM LEADER
(As per Document)
*Supervisor’s Contact No. 8272861665
Department SBI *Supervisor’s Email ID
*Remuneration
11110/- *HR Name PALLAVI SHARMA
(Last Drawn Salary)
PALLAVI.SHARMA2@TE
*HR Contact No. and
*Employee ID 100000000539978 LEPERFORMANCEDIB.C
email ID
OM
2 0 0 8 2 0
*Date of Joining
0 1 1 1 2 2
*Date of Exit

Reason for Leaving:

*Employment Type ✅ Full - Time Part-Time

*Nature of Employment Probation ✅ Permanent Contractual Temporary
Reliving Letter Experience Letter Service Letter ✅ Pay Slip
*Documents submitted
Other - _______________________

Third Party
(Name and complete
address)
(If through contract)

Yes No Date:_________
Can we contact HR /
Supervisor now (Y/N) if
No, then date:-

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 Employer 2
*Company Name
Company/Operation Closed Functional Re-located
Company Current Status
Merged with

Company also Known as

*Complete Company
Address with Landmark
(Where candidate has worked)

* Company Contact No.

*City *State
*Supervisor Name and
*Designation Designation
(As per Document)
*Supervisor’s Contact No.
Department *Supervisor’s Email ID
*Remuneration
*HR Name
(Last Drawn Salary)
*HR Contact No. and
*Employee ID
email ID
D D M M Y Y
*Date of Joining
D D M M Y Y
*Date of Exit

Reason for Leaving:

*Employment Type Full - Time Part-Time

*Nature of Employment Probation Permanent Contractual Temporary
Reliving Letter Experience Letter Service Letter Pay Slip
*Documents submitted
Other - _______________________

Third Party
(Name and complete
address)
(If through contract)

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 Employer 3
*Company Name
Company/Operation Closed Functional Re-located
Company Current Status
Merged with

Company also Known as

*Complete Company
Address with Landmark
(Where candidate has worked)

* Company Contact No.

*City *State
*Supervisor Name and
*Designation Designation
(As per Document)
*Supervisor’s Contact No.
Department *Supervisor’s Email ID
*Remuneration
*HR Name
(Last Drawn Salary)
*HR Contact No. and
*Employee ID
email ID
D D M M Y Y
*Date of Joining
D D M M Y Y
*Date of Exit

Reason for Leaving:

*Employment Type Full - Time Part-Time

*Nature of Employment Probation Permanent Contractual Temporary
Reliving Letter Experience Letter Service Letter Pay Slip
*Documents submitted
Other - _______________________

Third Party
(Name and complete
address)
(If through contract)

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Letter of Authorization from the Employee / Candidate
To whom so ever it may concern

I hereby authorize third party agency appointed by the Company to conduct background verifications
to validate the information I have provided to the Company including but not limited to my
employment, my personal background, professional standing, work history and qualifications etc.

I authorize, without reservations, any individual, company or other private or public entity to furnish
to the Company or the third party agency appointed by the Company, all information about me

I release and hold harmless any individual, company, or private or public entity from any and all
causes of action that might arise from furnishing such information to the Company or the third party
agency appointed by the Company that they may request pursuant to this release.

This authorization and release, in original, faxed or photocopied form, shall be valid for this and any
future reference.

Signature SumbU

Name
SYED SUMBUL SUHAIL
(In Block Letters)

Date of Birth 14/05/1995

Date 11/09/2022

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