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EMPLOYMENT VERIFICATION FORM

SYNOVA ID NUMBER: .
DATE OF JOINING:
Please provide complete and correct information. All fields are mandatory. Please do not
use short forms/Abbreviations. Take a printout of only the last page (Declaration and
Letter of Authorization). Please sign, scan it and send the same.
PERSONAL DETAILS
Full Name (Mr./Mrs./Ms.)
Fathers Name:
Mothers Name:
Date of Birth:

Blood Group:
Nationality:
Gender: Male / Female

Marital Status : Married / Unmarried


Name of Spouse:
Wedding Aniversary:
Maiden Name (applicable for married ladies):
Permanent Address:
Period of Stay:
Current Address:

From:

To:

Period of Stay:
From:
Intermediate Address:

To:

Nearest Police Station:


Telephone (Home):
Email Address:
NSR Registration Number (Mandatory)
Passport No. and PAN Number
(Mandatory)

Mobile:

EDUCATIONAL QUALIFICATION - Highest Degree (Incase studied directly through the


university, though correspondence or through distance education, please mention clearly)
College Name and Address
University Name and Address
From - To (Month/Yr)

Graduated
(Yes / No )

Type of Degree:

Graduation Date
(month/yr):

Copy of Certificate Attached:

Program
(Part-time /
Full-Time)

Yes

Social Security Number (Mandatory if Studied in U.S.A)

%/ Class Student Id
No./Enrolment No.

Major Subject:

No

EMPLOYMENT DETAILS: Please give the details of last employment and ensure that
you are descriptive wherever necessary-for e.g. If Co. is closed, please mention it. Please
mention the Company telephone number with specific location code. Employee
Code/ID/Number is Mandatory. If your previous employer did not provide the latter,
please mention and state reasons for the same. Please do not use abbreviations for
company names.
EMPLOYMENT 1 (LATEST) - Please attach a self attested copy of your relieving
letter/Service certificate for this.
Company Name:
Address (main office and branch where
worked):

Employment Period (dd/mm/yyyy)


From:

Position Held &


Dept:
Company Telephone
No. :

Reported to (Name & Name of HR


Position):
Manager:

To:

Whether employment is of permanent or temporary nature (Contract positions are


temporary)
Permanent

Temporary

Employee Code/Personnel No:

Social Security Number (Mandatory if worked in USA):


Responsibilities:
Last Monthly Gross Salary

Reasons for Leaving:

(Please attach the self-attested copy of your


last pay slip.)
Can verification be done now?
If No, When can it be done?

Yes

No

EMPLOYMENT 2 (LATEST) - Please attach a self attested copy of your relieving


letter/Service certificate for this.
Company Name:
Address (main office and branch where
worked):

Employment Period (dd/mm/yyyy)


From:

Position Held &


Dept:
Company Telephone
No. :

Reported to (Name & Name of HR


Position):
Manager:

To:

Whether employment is of permanent or temporary nature (Contract positions are


temporary)
Permanent

Temporary

Employee Code/Personnel No:

Social Security Number (Mandatory if worked in USA):


Responsibilities:
Last Monthly Gross Salary

Reasons for Leaving:

(Please attach the self-attested copy of your


last pay slip.)
Can verification be done now?
If No, When can it be done?

Yes

No

EMPLOYMENT 3 (LATEST) - Please attach a self attested copy of your relieving


letter/Service certificate for this.
Company Name:
Address (main office and branch where
worked):

Employment Period (dd/mm/yyyy)


From:

Position Held &


Dept:
Company Telephone
No. :

Reported to (Name & Name of HR


Position):
Manager:

To:

Whether employment is of permanent or temporary nature (Contract positions are


temporary)
Permanent

Temporary

Employee Code/Personnel No:

Social Security Number (Mandatory if worked in USA):


Responsibilities:
Last Monthly Gross Salary

Reasons for Leaving:

(Please attach the self-attested copy of your


last pay slip.)
Can verification be done now?
If No, When can it be done?

Yes

No

EMPLOYMENT 4 (LATEST) - Please attach a self attested copy of your relieving


letter/Service certificate for this.
Company Name:
Address (main office and branch where
worked):

Employment Period (dd/mm/yyyy)


From:

Position Held &


Dept:
Company Telephone
No. :

Reported to (Name & Name of HR


Position):
Manager:

To:

Whether employment is of permanent or temporary nature (Contract positions are


temporary)
Permanent

Temporary

Employee Code/Personnel No:

Social Security Number (Mandatory if worked in USA):


Responsibilities:
Last Monthly Gross Salary

Reasons for Leaving:

(Please attach the self-attested copy of your


last pay slip.)
Can verification be done now?
If No, When can it be done?

Yes

No

REFERENCES DETAILS:
(PLEASE GIVE DETAILS OF TWO PROFESSIONAL AND ONE ACADEMIC REFERENCE.
THEY SHOULD NOT BE RELATIVES OR FRIENDS.)
REFERENCE 1

REFERENCE 2

REFERENCE 3

NAME
ORGANIZATION/
INSTITUTION
POSITION
ADDRESS
TELEPHONE NO.
RELATIONSHIP
YEARS YOU HAVE
KNOW EACH
OTHER

IDENTITY CHECK: PAN CARD/ PASSPORT / DRIVERS LICENSE


PLEASE ATTACH ONE OF THE ABOVE DOCUMENTS MENTIONED
Type of Document
Mentioned Name
Passport / PAN No.
Date of Birth
Fathers Name
Place of Residence
Date of Issue
Place of Issue
Expiry Date

Declaration
I hereby certify all of the statements made on the SYNOVA employment verification
form are true and complete and I understand that omission or misrepresentation of any
fact may result in refusal of employment or immediate dismissal.
I recognize that in connection with employment with SYNOVA. I may be the subject of
a background enquiry by SYNOVA or its representative and I hereby authorize the same.
Signature

Name in Capital

Date

Letter of Authorization

To whom it may concern


I hereby authorize SYNOVA representative to verify information provided in my resume
and application of employment and to conduct enquiries as may be necessary at the
companys discretion. I authorize all persons who may have information relevant to this

enquiry to disclose it to SYNOVA or its representative. I realize all persons from liability
on account of such disclosure.
Signature

Name in Capital

Date