Background Verification Form

NIIT Limited

Applicant No/ Employee ID Location Date of Joining

Please provide complete and correct information. All fields are mandatory.

Please do not use short forms / abbreviations.

Personal Details

Full Name (First, Middle, Last)

Former Name(s) / Maiden Name (if applicable) Gender:

 Male  Female

Father’s Name Date of Birth (dd/mm/yy) Aadhar Number

Current Address: Period of Stay

From (dd/mm/yyyy) To: (dd/mm/yyyy)

Prominent Landmark: Landline Number –

Mobile Number -

Permanent address: Period of Stay

From (dd/mm/yyyy) To: (dd/mm/yyyy)

Landline Number –
Prominent Landmark:

Mobile Number -
 Education Section

Highest qualification(Academic Qualification) - 1

(Please attach copy of degree certificate and final year mark sheet for this)

College / Institute
Name

College / Institute
Address

University Name and

Address

From - To Graduated Program Roll No /

(month / year)  Yes  Full Time Enrollment No.
 No  Part Time

Type of degree Graduation date Subject Major

(month / year)

Copy of the Certificate Attached  Yes  No

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

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Highest qualification(Academic Qualification) – 2
(Please attach copy of degree certificate and final year mark sheet for this)

College Name/
Institute

College/ Institute
Address

University Name and

Address

From - To Graduated Program Roll No /

(month / year)  Yes  Full Time Enrollment No.
 No  Part Time

Type of degree Graduation date Subject Major

(month / year)

Copy of the Certificate Attached  Yes  No

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

Employment Section

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 Please give details of all companies

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) Employee Code/

Personnel No:
From To

Reporting Manager Name & Designation Contact No of Email ID of Reporting

Reporting Manager: Manager:

Whether employment is of permanent or temporary nature -  Permanent  Temporary

Agency Details (if temporary or contractual)

Remunerations Reason(s) for Leaving

Can a reference be taken now? Yes / No

If no, when can it be taken?

Employment Section

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 Please give details of all companies worked in last 5 yrs.

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) Employee Code/

Personnel No:
From To

Reporting Manager Name & Designation Contact No of Email ID of Reporting

Reporting Manager: Manager:

Whether employment is of permanent or temporary nature -  Permanent  Temporary

Agency Details (if temporary or contractual)

Remunerations Reason(s) for Leaving

Can a reference be taken now? Yes / No

If no, when can it be taken?

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

Page 5 of 9
Company Name (3) : Position Held & Department

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

Employment Period: (date, month, year) Employee Code/

Personnel No:
From To

Reporting Manager Name & Designation Contact No of Email ID of Reporting

Reporting Manager: Manager:

Whether employment is of permanent or temporary nature -  Permanent  Temporary

Agency Details (if temporary or contractual)

Remunerations Reason(s) for Leaving

Can a reference be taken now? Yes / No

If no, when can it be taken?

Page 6 of 9
 Please attach a copy of your relieving letter/service certificate for this

Company Name (4) : Position Held & Department

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

Employment Period: (date, month, year) Employee Code/

Personnel No:
From To

Reporting Manager Name & Designation Contact No of Email ID of Reporting

Reporting Manager: Manager:

Whether employment is of permanent or temporary nature -  Permanent  Temporary

Agency Details (if temporary or contractual)

Remunerations Reason(s) for Leaving

Can a reference be taken now? Yes / No

If no, when can it be taken?

Page 7 of 9
 Declaration and Authorization 
                     
I hereby authorize NIIT 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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 Documents Required - Mandatory

For Education Verification:

 Photocopy of the degree certificate and final year mark sheet would be required.

For Bangalore University:

 A Photo Copy of both the sides of the Degree Certificate (The reverse side of the
certificate has some information which the University would require).
 Copies of the Marks Sheets/Grade Card for all the years of attendance.
 Name of the College through which the candidate has graduated.)

For Employment Verification:

 Photocopy of relieving/experience certificate

For Address Verification:

 Need complete address, period of stay, with nearest landmark with pin code along
with Passport size photo (Mumbai) Location.

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