Antecedent / Background Verification Form

(For Unskilled Workers)

Worker Information

Employee ID:

Employee Name: Father Name: Permanent Address: PIN CODE: Contact Number: Email ID: Date of Birth: Gender: Male Female Marital Status: Married UnMarried Designation: HK Worker HK Sweeper HK Lady HK Supervisor Joining Date: Site Name: AADHAAR NUMBER: PAN NUMBER (Optional): Account Number: IFSC Code: Bank Name:

Previous Employment

Previous Employer: Position Held: Employment Duration: Reason for Leaving:

Criminal Record

Ever convicted? Yes No If yes, details:

Educational Qualification

Highest Qualification: School/College Name:

Character References

Reference 1 (Name, Contact): Reference 2 (Name, Contact):

Declaration

I, , hereby declare that the information provided is true and accurate to the best of my knowledge. I understand that any false information may result in the termination of my employment.

For Office Use

Remarks: Verified By: