ARTECH INFOSYSTEMS PVT LTD

BACKGROUND VERIFICATION FORM

Employee Code

Name

Father’s Name

Date of Joining

Designation

Date of Birth

Present Address

E-Mail ID

Telephone No.

Permanent Address

E-Mail ID

Telephone No.

Contact Person (In

case of Emergency)

Contact Number (In

case of Emergency)

Signature of Employees Signature

Verified by HR
 Educational and Employment Verification Information Sheet
Employee Name

Documents Comments
Highest
Final Year Mark Sheet
Highest Degree Certificate

Documents Comments
Second
Final Year Mark Sheet
Education
Degree Certificate

Employee ID
Experience / Relieving Letter
Last or Current
Employer
Resignation Letter
Pay Slip
Employee ID
Second Experience / Relieving Letter

Employer Resignation Letter

Pay Slip

APPLICATION FORM

Please fill in the details with utmost attention, as these shall be verified by Artech Infosystems and/ or
by its authorized representative. All details are compulsory.

Personal Details
 Name of the Applicant: Surname Middle First

Date of Birth (dd/mm/yy): Place of Birth

Sex: Nationality :

Father’s Name: Passport No:

Emp ID: Contact No:

Employment Record: Starting with your present or most recent employer, please list last 3
employments. Complete and accurate dates (month/year) each and every must be provided
Important: Relieving letter and Experience letter copy must be attached in case of unavailability of the same
please attached the Appointment letter and Resignation acceptance mail.

Details of Current or last Employer Employee ID: From: To:

Company Name:

Company Address: Employer Contact and Fax No:

City: State: Country: Postal Code:

Job Title: Reason for Leaving:

Employment Status: Supervisor Details: Name and Designation / Contact No:

Description of Duties: HR Details: Name and Designation / Contact No:

Details of Second Last Employer Employee ID: From: To:

Company Name:

Company Address: Employer Contact and Fax No:

City: State: Country: India Postal Code:

Job Title: Reason for Leaving:

Employment Status: Supervisor Details: Name and Designation / Contact No:

Description of Duties: HR Details: Name and Designation / Contact No:

Details of Third Last Employer Employee ID: From: To:

Company Name;

Company Address: Employer Contact and Fax No:

City: State: Country: Postal Code:

Job Title: Reason for Leaving:

Employment Status: Supervisor Details: Name and Designation / Contact No:

Description of Duties: HR Details: Name and Designation / Contact No:

Details of Fourth Last Employer Employee ID: From: To:

Company Name;

Company Address: Employer Contact and Fax No:

City: State: Country: Postal Code:

Job Title: Reason for Leaving:

Employment Status: Supervisor Details: Name and Designation / Contact No:

Description of Duties: HR Details: Name and Designation / Contact No:

Details of Fifth Last Employer Employee ID: From: To:

Company Name;

Company Address: Employer Contact and Fax No:

City: State: Country: Postal Code:

Job Title: Reason for Leaving:

Employment Status: Supervisor Details: Name and Designation / Contact No:

Description of Duties: HR Details: Name and Designation / Contact No:

Details of Sixth Last Employer Employee ID: From: To:

Company Name;

Company Address: Employer Contact and Fax No:

City: State: Country: Postal Code:

Job Title: Reason for Leaving:

Employment Status: Supervisor Details: Name and Designation / Contact No:

Description of Duties: HR Details: Name and Designation / Contact No:

 Education: Starts with highest education.
Important: Copy of Consolidate Mark sheet and Degree certificate MUST be attached

Course Dates Attended

Name & Address Name of Degree /
Name & Address of Attended Roll No /
of Diploma (Also
University / Affiliated (Regular/C From To Registration
School/College/In indicate
Institute orrespond No:
stitute specialization)
ence)

Information Release Authorization

▪ I certify that the statements made in this application are valid and complete to the best of my
knowledge. I understand that false or misleading information may result in termination of
employment.
▪ If upon investigation, any of this information is found to be incomplete or inaccurate, I understand
that I will be subject to dismissal at any time during my employment.
▪ I hereby authorize Artech Infosystems and/or any of its subsidiaries or affiliates, and any persons or
organization acting on its behalf to verify the information presented on this application form and to
procure an investigation report or consumer report for that purpose.
▪ I hereby grant authority for the bearer to access or to be provided with full details of my previous
record. In addition, please provide any other pertinent information requested by the individual
presenting this authority.
▪ I hereby release from liability all persons or entities requesting or supplying such information.
▪ I authorize to contact my present and past employer. Yes No
▪ I have read, understand, and by my signature consent to these statements.

Signature:
Date:
Name:

** As is the procedure followed by most police departments across India for criminal back ground
verification, it is possible that police authorities may contact or visit the stated residence and at times
even ask to be physically present at the concerned police station. It is part of the standard verification
procedure.
 Letter of Authorization:

To whomsoever it may concern

I hereby authorize ARTECH INFOSYSTEMS PVT LTD and its authorized representatives to verify
information provided in my resume and application of employment, and to conduct enquiries as may
be necessary, at the company’s discretion. I authorize all persons who may have information relevant
to this enquiry to disclose it to ARTECH INFOSYSTEMS PVT LTD or its representative. I release all
persons from liability on account of such disclosure.

I hereby authorize concerned authorities to dispatch my confidential report to ARTECH

INFOSYSTEMS PVT LTD or its authorized representative.

Signed:

Name:

Date:

** As is the procedure followed by most police departments across India for criminal back ground
verification, it is possible that police authorities may contact or visit the stated residence and at times
even ask to be physically present at the concerned police station. It is part of the standard verification
procedure.