Background Verification Form

Personal details (in

BLOCK LETTERS)
To be filled completely and clearly by the candidate *Indicates Mandatory fields
First Name* Middle Name
Last Name*

Fathers
Name*
Personal
Email ID
Date of
Birth*
(dd/mm/
yyyy)
Gender*
Marital
Status*
Place of
Birth
Mobile
Number*
Land Line
Number
PAN
Number *
Nationalit
y*
Passport
No.
Emergenc
y contact
persons
name
with
Mobile

1| Page Signature of the candidate: _______________

Present Address
Details (With City/Town
and District details)*

Highest completed
Educational Details*
Pin Code: State: Country:
University Institution /
Degree/ Registra Date
Name and College
Diploma tion
Gradua
Address *(Provide full (BA,BSC, Number ted/
*(Provide name &
MA,MSC, /
Comple
full name & Address)
etc. Area Enrolme ted*

Latest Employment Details

Name of
Company,
Address
and
Phone
Number*
Start Date
dd/mm/yyyy*
Employee
ID*
Empl
Compensati
oy
on in INR
ment
(CTC per
1
annum)*

Were you
deputed
through
an
agency(If
yes
company
Name
name,of
Company,
address
Address
and
and Phone
Number*
Start Date*
dd/mm/yyyy
Employee
ID*
Emp
Compensati
loy
on in INR
men
(CTC per
t2
annum)*

Were you
deputed
through
an
agency(If
yes
company
name,
address

Background Verification Form

2| Page Signature of the candidate: _______________

End Date
dd/mm/yyy
y*
Last
Designati
on*
Superviso
r's Name:*
Designati
on:*
Departme
nt:*
Contact
Number*:
Email ID:*

End Date*
dd/mm/yyy
y
Last
Designatio
n*
Superviso
r's Name:*
Designatio
n:*
Departme
nt:*
Contact
Number*:
Email ID:*

Background Verification Form

Authorization Letter

I hereby authorise, without reservation, Janalakshmi Financial Limited, its sister concerns and its agents (including third
party) to conduct a full investigation into my background and activities at any point after this authorisation, and, if hired,
throughout my employment. Therefore, I hereby authorise the release of any and all information pertaining to me,
documentary or otherwise, as requested by any employee, agent (including third party) or representative of Janalakshmi
Financial Limited and its sister concerns.
I understand that during this background verification process, documents or statements or testimonials, may be obtained,
concerning my character, general reputation, personal characteristics, and mode of living. The nature and scope of any
investigation may include, but is not limited to employment, credit, education, criminal and residence history. I release all
courts, probation departments, employers, educational institutions, banks, financial and other institutions, law enforcement,
and district, state and central government departments and agencies, without exception, both foreign and domestic, to
furnish any and all background information (including, but not limited to driving and/or motor vehicle records) requested by
Janalakshmi Financial Limited, its sister concerns and its agents (including third party).
I understand that this information may be transmitted electronically, and authorise such transmissions. I agree that a
photocopy of this release shall be accepted with the same authority as the original.

Name in Block Capitals:

Signature of the
candidate :
Place
Date (DD/MM/YYYY):

3| Page Signature of the candidate: _______________