BACKGROUND VERIFICATION FORM

Please provide complete and accurate information

Name in Elchuri / NA / Lakshman

full
(Block letters) First Name Middle Name Last Name

Date of Birth
28 05 1992`

Father’s Name Srinivasarao

Present / Current Address Permanent Address

chennupalli post , ballikurava chennupalli village , ballikurva mdandal

mandal , ongole dist ongole dist

523303 523303

Period of Stay (month/year) : To From Period of Stay (month/year) : To From

8297914075 8297914075
Tel/Mobile No Tel/Mobile No

Email Id : [email protected]

Gender: M Nationality: Indian

Educational Qualifications (Highest Qualifications – Graduate or Post Graduate

Degree/Diploma)

(IMPORTANT: Copy of final year mark sheet /degree certificate MUST be attached)

College Name & pnc &vijay collage of engg

Address
University Name
and Address Acharya nagarjuna university

From Aug-2009
- Graduated Program Student ID No
To / Enrollment
(month / year) Yes Full Time No.
 No  Part Time
April y9it2005

Type of degree : Graduation date Subject Major :

B-tech april-
(month/year) : IT
2013

Document Ref: KQVOE-XBO8Q-2NWYF-EIQNM Page 1 of 6

 Employment History in Chronological Order : Details Required for Last 3 employments

(IMPORTANT: Copy of Relieving Letter /Service Certificate/Salary Slips MUST be attached)

Current INBREDIA Technologies pvt ltd Position Held & Tech Lead & IT
Company Name Department
& Branch

Address (main office and branch where worked): Reporting Nikhil R,

Telephone To(Supervisor)
[email protected]
Telephone:

10th Floor,Tower – B, Unitech Cyber Park, Sector Reporting To Saikumar

(From Other
– 39, Gurgaon, Haryana, India – 122003. Team):

Employment Period: (date, month, Employee Code: IT-51903 Type of Employment:

year)  Permanent
From
30-08-2020 To
31-Ja- Last Drawn Salary:
13.50  Contractual
22
Agency Details (if temporary or contractual)/ Clients Reported to
Citico Group client

Can we verify Current employment details?

 YES
 NO

Previous WIPRO Limited Position Held & Tech Lead

Company Name Department
& Branch (I)

Address (main office and branch where worked): Reporting

Telephone: To(Supervisor):
raj vudammarri

Telephone:

Reporting To
Pune , hinjawadi no
(From Other
Team):

Employment Period: (date, month, year) Employee Code: 2122486 Type of Employment
From To  Permanent
2018-july aug-2019 Last Drawn Salary:  Contractual

7.5

Agency Details (if temporary or contractual) / Clients Reported to

credit Suisse client

Document Ref: KQVOE-XBO8Q-2NWYF-EIQNM Page 2 of 6

 Previous Pyrimid It Position Held & Software lead
Company Name Department
& Branch (II)

Address (main office and branch where worked): Reporting

Telephone: To(Supervisor):

Telephone:

Noida , india Reporting To

(From Other
Team):

Employment Period: (date, month, year) Employee Code: Type of Employment

n2186
From To  Permanent
july-2017 july-2018 Last Drawn Salary:  Contractual

6.5

Agency Details (if temporary or contractual)

hsbc Client

Previous Position Held &

Company Name Department
& Branch (III)

Address (main office and branch where worked): Reporting

Telephone: To(Supervisor):

Telephone:

Reporting To
(From Other
Team):

Employment Period: (date, month, year) Employee Code: Type of Employment

From To  Permanent
Last Drawn Salary:  Contractual

Agency Details (if temporary or contractual) /Clients Reported to

Document Ref: KQVOE-XBO8Q-2NWYF-EIQNM Page 3 of 6

 I hereby authorize On Demand Agility Software Private Limited and its representative
to verify information provided in my application of employment and to conduct enquiries as
may be necessary at the company’s discretion. I authorize all persons who may have
information relevant to this enquiry to disclose it to On Demand Agility Software Private
Limited or its representatives.

Name: lakshman

Signature:

Date:
22 / 02 / 2022

Document Ref: KQVOE-XBO8Q-2NWYF-EIQNM Page 4 of 6

 Letter of Authorization

To whomsoever it may concern

I understand that “On Demand Agility Software Private Limited” and/or any entity
directed by “On Demand Agility Software Private Limited” may verify and validate the
information I have provided in my resume and during my interviews including my past
employment, professional conduct, personal background, work history and educational
qualifications.

I understand that “On Demand Agility Software Private Limited” and/or any entity
directed by “On Demand Agility Software Private Limited” may obtain information it
deems appropriate from various sources including, but not confined to, the following:
current and past employers, criminal conviction records, school records, college records,
professional and Personal references.

I authorize, without reservation, any individual, corporate or other private or public entity to
Furnish “On Demand Agility Software Private Limited” and/or any entity directed
by “On Demand Agility Software Private Limited” all information about me.

I unconditionally release and hold harmless any individual, corporation, or private or public
Entity from any and all causes of action that might arise from furnishing to “On Demand
Agility Software Private Limited” and/or any entity directed by “On Demand
Agility Software Private Limited” information 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 further reports and updates that may be requested.

If any information provided our found to be false, company has complete rights to revoke
the offer letter with immediate effect.

Signature:

Name in Capital Letters: LAKSHMAN

Date:
22 / 02 / 2022

Document Ref: KQVOE-XBO8Q-2NWYF-EIQNM Page 5 of 6

 Details of family Members : 4

Any of your family members work in the Political establishment -------Yes / No

If yes please furnish the below details

Name na
Department na
Job Title na

Any of your family members work in Government establishments -------Yes / No

If yes please furnish the below details

Name na
Department na
Job Title na

Please provide the following details :

Father's name srinivasarao

Profession na
Department
na

Mother's name rangamma

Profession homemaker
Department
na

Document Ref: KQVOE-XBO8Q-2NWYF-EIQNM Page 6 of 6

Signature Certificate
Reference number: KQVOE-XBO8Q-2NWYF-EIQNM

Signer Timestamp Signature

Lakshman
Email: [email protected]

Sent: 21 Feb 2022 14:03:57 UTC

Viewed: 21 Feb 2022 14:23:33 UTC
Signed: 22 Feb 2022 09:07:52 UTC IP address: 157.47.100.23
Location: Hyderabad, India

Document completed by all parties on:

22 Feb 2022 09:07:52 UTC

Page 1 of 1

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