Background Verification Form

Applicant No./Employee Location:Calicut Date of Joining / interview:

ID:ES 108 15.10.2022
Personal Details
Applicant Name Shebija.V.K
(First name, Middle name,
Sur name)
Former Name/Maiden
Name (If applicable)
Date of Birth: 18.03.1973 Father’s Name: Velayudhaswami.V.K

Gender Female Nationality. Indian Marital Status. Married

Email ID:Nil Mobile No: 9539377519

Current Address: Kottakkunnu,Aduvad Period of stay form (mm/yy)
Mavoor (PO) Calicut 673661 to (mm/yy)

Permanent Address: Same As Above Period of stay form (mm/yy)

to (mm/yy)

Educational Details (Highest Qualification)

Name of the College
Address of the College
Name of the University
Name of the Course: Major Subject: From – To: Full Time
Part Time

Copy of certificate attached

Exodus Facility Management, 62/1468,CPM Complex,Calicut-673001

E-mail.exodusclt12@gmail.com

 Employment History
Name of current Employer: Exodus Address:CPM Complex ,Kannur
Facility Management Road ,Calicut,PIN 673001
Employee ID:ES 108 Work Period Designation: Department:
From:15.10.22 Hygiene
To: Professional
Reporting Manager Name & Email Id:
Designation: Contact No:9539377519
Position Permanent Last Drawn Reason for Leaving:
Contract. Yes Salary:10,500/-
Temporary
Documents Submitted for This Employment
Experience Certificate Relieving Letter Payslips Any Other
Previous Employer (1)
Name of the Employer: Address: Calicut
Iqra International Hospital,
Employee ID: Work Period Designation:Hygien Department:
From: 2018 e Professional
To: 2019
Reporting Manager Name & Email Id:
Designation: Contact No:
Position Permanent Last Drawn Salary: Reason for Leaving:
Contract 10,000/-
Temporary
Experience Certificate Relieving Letter Payslips Any Other
Previous Employer (2)
Name of the Employer: Address:
Manohar Hospital
Employee ID: Work Period Designation Department:
From:2020
To: 2021
Reporting Manager Name & Email Id:
Designation: Contact No:
Position Permanent Last Drawn Reason for Leaving:
Contract Salary:9500
Temporary
Experience Certificate Relieving Letter Payslips Any Other

 Declaration
I confirm that the above information is true to the best of my knowledge and
understanding.

Applicant Name: Shebija.V.K____. Signature: __________________

Date:15.10.22

Exodus Facility Management, 62/1468,CPM Complex,Calicut-673001

E-mail.exodusclt12@gmail.com