Britannia Background Check Form

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Background Verification Form - Britannia

Instructions : Please provide required information requested in this form. All supporting documents must accompany this form. Photocopies must be legible.

PERSONAL INFORMATION

First Name: __________________Middle Name: __________________

Last Name: ______________

Employee ID: __________ Location: ___ _____

Fathers Name: _________________________________________________(Expand the initials)

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

Proof of DOB (please enclose Birth Certificate or 10th Mark sheet or Passport Copy)

Change of Name if Applicable

Former Name/Maiden Name _____________________________ ________________________________

Date of Name Change ___________________________

For Internal Use OnlyCandidate Reference No: ___________________

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Please Affix Recent Passport Sized photograph

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ADDRESS DETAILS

Note: Please attach legible Photo copies of the following, relevant to the entries.Proof of Address: (Photocopy of Passport, Voters ID, Ration Card, Rent agreement & Utilities bill)

Current Address

Door No / Street:City:State:Pin:Landmark:Landline / Mobile:Period of Stay: (Please Write Start Date or start Month to Till date )Is your current residence owned or a rented place?If rented, please provide details of the Landlord

If above current address is less than 6 months please provide previous address details

Previous Address Details-1

Door No / Street:City:State:Pin:Landmark:Period of Stay:Please Write Start Date or start Month to End date )Contact Details Name:

Address:

Land Line/Mobile No

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Permanent Address

Door No / Street:City:State:Pin:Landmark:Landline / Mobile:Period of Stay:

Is your residence your own or a rented place?If rented, please provide details of the Landlord

Note: Please attach legible Photo copies of the following, relevant to the entries.Proof of Address: (Photocopy of Passport, Voters ID, Ration Card, Rent agreement & Utilities bill)

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EDUCATION DETAILS

Have you obtained your educational qualification (Graduation / Highest Level of Educational Qualification outside India? Yes/No--- No

Education (Graduation)

Name of College/Study Centre

Name of Board / University

Address of College/Study Centre

Student ID No:/ Enrolment No

Division / Class

Subject Major

Note: Please Enclose legible Photo Copies of the following documents relevant to the entries above1) Mark sheets of all semesters/years2) Degree Certificates, FRONT and BACK or Provisional Certificate3) Initial two and lat one page of Passport Copy

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Highest Education-1(Post Graduation Or professional Degree)



Address of College/Study Centre

Student ID No:/ Enrolment No

Division / Class

Subject Major


Highest Education-2 (Post Graduation Or professional Degree/PhD etc)



Address of College/Study Centre City: State:Pin: (: (Landline)*: (Email ID)

Student ID No:/ Enrolment No Period of Study

Division / Class Degree Obtained

Subject MajorCourse Type (Regular/Distance


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VerifactsEMPLOYMENT DETAILSNote: Please furnish last 2 employment details.

Employment -1

PERMANENT EMPLOYMENT

Name of Company

Where were you employed? Registered Corporate Office

Branch Office

Company Address

(Where were you employed ) ( (Contact Details)

Period of employment

(Start & End Date)

Employee Code

Designation and Department Remuneration

Supervisor’s (Reporting Manager) Name and Designation

(Phone No

(Email Id

HR contact details (Name and Designation)

(Phone No.

(Email Id

Reason for leaving

Can a reference be taken now? o Yes o No

If No, when can it be taken?

CONTRACTUAL EMPLOYMENT

Name of Company & Address

* (Email Id) ( (Landline)

Designation: Period of employment(Start & End Date)

Employee CodeReason for leaving

Company Contact Person

* (Email Id)

( (Landline)

Note: Please attach legible Photo copies of the following documents relevant to the entries above 1) Appointment Letter 2) Release Letter or service certificate 3) Pay Slips.

Previous Employment - 2

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PERMANENT EMPLOYMENT

Name of Company

Where were you employed? Registered Corporate Office Branch Office

Company Address

(Where were you employed )( (Contact Details)

Period of employment

(Start & End Date)

Employee Code

Designation and Department Remuneration

Supervisor’s (Reporting Manager) Name and Designation

(Phone No

(Email Id

HR contact details (Name and Designation)

(Phone No.

(Email Id

Reason for leaving

Can a reference be taken now? o Yes o No

If No, when can it be taken?

CONTRACTUAL EMPLOYMENT

Name of Company & Address

* (Email Id) ( (Landline)

Designation: Period of employment(Start & End Date)

Employee CodeReason for leaving

Company Contact Person

* (Email Id)

( (Landline)

Note: Please attach legible Photo copies of the following documents relevant to the entries above 1) Appointment Letter 2) Release Letter or service certificate 3) Pay Slips.

Professional References:

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Ref 1:

Name

Company/Designation

Landline Mobile E-mail Id

Ref 2:

Name

Company/Designation


Ref 3:

Name

Company/Designation


Ref 4:

Name

Company/Designation


Letter of Authorization 9

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To whom it may concern

I understand that Britannia may use an outside agency to verify and validate the information I have provided as a part of my employment application, including my employment, my personal background, professional standing, work history and qualifications.

I authorize, without reservation, any individual, corporation or other private or public entity to furnish Britannia.

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 Britannia and the outside agency 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 future reports and updates that may be requested. I also authorize, without reservation, Britannia to share the details obtained by these checks, whether fully or in part, with third parties (including, without reservation, with statutory bodies, customers or vendors), Infosys will exercise due care while sharing these details.

Name: ______________________________

Employee Number: _____________________

Signature: _____________________________ Date: _______

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VerifactsI hereby certify that all information provided herein, is true and complete to the best of my knowledge and belief. I authorize Britannia and its representative to authenticate information I have provided in this BG Verification form. To conduct enquiries as may be necessary at the company’s discretion, I authorize all who may have information relevant to this enquiry to disclose it Britannia and/or its representative. I release all concerned from any liability on account of such disclosures.

I also declare that the information provided by me in this application for employment to Britannia and its representative is authentic and I am liable for all inaccuracies and omissions.

I promise to extend total co-operation and provide relevant documents required.

Full Name of the Candidate: ___________________________________ Signature of the Candidate Place: ____________________________________________________

Date: _____________________________________________________

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Documents to be furnished by the candidate for verification

Employment verification:

1. Relieving Letter with employee code duly signed by the authorized official. 2. Service certificate with employee code duly signed by the authorized official. 3. Salary slips

Address verification:

1. Photocopy of Passport 2. Voters ID3. Ration Card 4. Rent agreement 5. Utilities bill.

Note: All the documents should have candidates name on it.

Clear Background Verification form with all the necessary components duly filled by the candidate.

Letter of Authorization duly signed by the candidate along with date is mandatory.

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