Background Verification Form

Seaton India IT Private Limited

Applicant No/ Employee ID*

Location*

Date of Joining*

Please provide complete and correct information. All fields are mandatory indicated with
an asterisk. Please do not use short forms / abbreviations.
Personal Details
Full Name (First, Middle, Last) **

E-mail ID**

E-mail ID**
Former Name(s) / Maiden Name (if applicable)

Gender:
Male

Fathers Name**

Female

Date of Birth (DD/MM/YY)**

Permanent Address with nearest landmark

and Pin code**

Social Security Number

(if applicable)

Period of Stay**
From (DD/MM/YYYY) To: (DD/MM/YYYY)
Landline Number**
Mobile Number** -

Current Address with nearest landmark and

Pin code**

Period of Stay**
From (DD/MM/YYYY) To: (DD/MM/YYYY)
Landline Number**
Mobile Number** -

Education Section

Highest qualification
(Please attach copy of degree certificate and final year mark sheet for this)
College Name**

College Address**

University Name and

Address**

From - To
(month / year)**

Graduated
Yes
No

Type of degree **

Copy of the Certificate Attached

Program
Full Time
Part Time

Roll No /
Enrollment No.**

Graduation date
(month / year)

Subject Major

Yes

SSN No. (mandatory if studied in USA or Canada):

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No

Employment Section
Please give details of last 02 Employments
Ensure that you are descriptive wherever necessary e.g. If Company. is closed, do
mention it. Employee Code/ ID/ Number are mandatory. If your last employer did not
provide one, please mention and state reasons for the same.

Please attach a copy of your relieving letter/service certificate for this

Company Name** (1) :

Position Held & Department**

Address (main office and branch where worked)**:

Telephone:

Employment Period: (date, month, year)**

From

Employee Code/
Personnel No**:

Name of Reporting
Manager**

Contact No of
Reporting Manager**:

Email ID of Reporting
Manager**:

To

Designation & Department of Reporting

Manager**

Whether employment is of permanent or temporary nature - Permanent Temporary

Agency Details (if temporary or contractual)

Remunerations

Can a reference be taken now? Yes / No

If no, when can it be taken?

Page 3 of 5

Reason(s) for Leaving**

Employment Section
Ensure that you are descriptive wherever necessary e.g. If Company. is closed, do
mention it. Employee Code/ ID/ Number are mandatory. If your last employer did not
provide one, please mention and state reasons for the same.
Please attach a copy of your relieving letter/service certificate for this

Company Name ** (2) :

Position Held & Department**

Address (main office and branch where worked)**:

Telephone:

Employment Period: (date, month, year)**

From

Employee Code/
Personnel No**:

Name of Reporting
Manager**

Contact No of
Reporting Manager**:

Email ID of Reporting
Manager**:

To

Designation & Department of Reporting

Manager**

Whether employment is of permanent or temporary nature - Permanent Temporary

Agency Details (if temporary or contractual)

Remunerations

Can a reference be taken now? Yes / No

If no, when can it be taken?

Page 4 of 5

Reason(s) for Leaving**

Declaration and Authorization

I hereby authorize Seaton India IT Private Limited Or a (third party agent appointed by
the Company) to contact any former employers as indicated above and carry out all
Background Checks not restricted to education and employment deemed appropriate
through this selection procedure. I authorize former employers, agencies, educational
institutes etc. to release any information pertaining to my employment/education and I
release them from any liability in doing so.
I confirm that the above information is correct to the best of my knowledge and I
understand that any misrepresentation of information on this application form may, in the
event of my obtaining employment, result in action based on company policy.

Signature: ________________________________________________________________

Name:

________________________________________________________________

Date:

________________________________________________________________

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