Optimum Solutions Pte Ltd

Background Vetting Form

Applicant No/ Employee ID Location Date of Joining/Interview Onsite/Regular

Please provide complete and correct information. All fields are mandatory. Please do not use short forms / abbreviations.
Personal Details
Full Name (First, Middle, Last) SHRINIVAS GANESAN Former Name(s) / Maiden Name (if applicable) Gender: MALE Male Female Residence Number and Mobile Number 0674-2531122 +91-9840460532

Date of Birth (dd/mm/yy) 01/06/83

Fathers Name DR. K.S. GANESAN Social Security Number --Voter ID #

Passport No : F8764399 Nationality INDIAN

Details of Addresses
Complete Address From:(mm/yy) To: (mm/yy) (Approximate) 03/13 TILL DATE Tel No. / Cell No. (With area code) +91 9840460532

Current Address

Door No. D1, 4th FLOOR, SRI SAI SELVA PG, VINAYAGA NAGAR, THORAIPAKKAM, CHENNAI, TAMILNADU - 600096 QR. NO 5, TYPE VII, UNIT 1, BHUBANESWAR, ORISSA - 751009

Previous Address (Longest Stay in past 5 years)

06/2010 12/2011

(91-674) 2531122

Previous Address Same as above (Longest Stay in past 7 years) Note: Please provide complete address including room number, bldg number in the above columns with valid phone nos.

Optimum Info System Private Limited

Educational Qualification
Highest Qualification Attained: (IMPORTANT: Copy of marksheet and degree certificate MUST be attached) College Name (1) College Address KALINGA INSTITUTE OF INDUSTRIAL TECHNOLOGY PATIA, BHUBANESWAR, ORISSA

University Name and Address From - To (month / year) 05/2001 05/2005 (Please provide the month) Type of degree B.TECH (Engineering)

KIIT, BHUBANESWAR (DEEMED UNIVERSITY)

Graduated Yes No YES

Program Full Time Part Time FULL TIME Graduation date (month / year) 05/2005

Roll No / Enrollment No. 2K1562

Subject Major Electronics and Telecommunication

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Please give details of previous employers Ensure that you are descriptive wherever necessary e.g. If Co. is closed, do mention it. Employee Code/ ID/ Numbers are mandatory. If your last employer did not provide one, please mention and state reasons for the same. Employment History Details of Current or Last Employer
Company Name (1) : Tata Consultancy Services Position Held & Department: IT Analyst, Software Development Telephone: +91 44 67422222 Reported to (Name, Position & Contact Number): Rojer Jayakumar, Team Lead Alternate Supervisor: (Name Position & Contact Number): N/A Whether employment is of permanent or temporary nature Permanent Temporary Permanent Agency Details (if temporary or contractual) N/A Remunerations -Rs. 5,41,000 per year Reason(s) for Leaving Got a new job heading for better career prospects

Address (main office and branch where worked): Tata Consultancy Services, Siruseri, Chennai - 603103 Employment Period: (date, month, year) From 06-OCT-2010 TILL DATE

Employee Code: 382376

Can a reference be taken now? Yes / No No If no, by which date we can contact them? June 2013

Please note that correct information like date of employment and valid phone nos. i.e. phone nos which are working are provided Enclose exp. certificate or relieving letter of above employment

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Optimum Info System Private Limited

Details of Previous Employers
Company Name (2) : Wipro Technologies Position Held & Department Senior Software Engineer in ORACLE Telephone: 080-28440011

Address (main office and branch where worked): Wipro Technologies, Doddakanneli, Sarjapur Ring Road, Bangalore - 560035 Employment Period: (date, month, year) From To 11-Jan-2010 04-June-2010

Employee Code: 185510

Reported to (Name, Position & Contact Number): Nisha Bhujang, Project Manager Alternate Supervisor: (Name Position & Contact Number): N/A

Whether employment is of permanent or temporary nature - Permanent Temporary Permanent Agency Details (if temporary or contractual)

Remunerations Rs. 4,70,000 per year Cana reference be taken now? Yes / No No If no, by which date we can contact them? N/A

Reason(s) for Leaving Resignation in search of job at other location

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Optimum Info System Private Limited

Details of Previous Employers

Company Name (3) : Wipro Technologies Position Held & Department Software Engineer, Oracle Telephone: 080-28440011

Address (main office and branch where worked): Wipro Technologies, Doddakanneli, Sarjapur Ring Road, Bangalore - 560035

Employment Period: (date, month, year) From To 01-AUG-2005 17-MAR-2009

Employee Code: 113881

Reported to (Name, Position & Contact Number): Nisha Bhujang, Project Manager Alternate Supervisor: (Name Position & Contact Number)

Whether employment is of permanent or temporary nature - Permanent Temporary Permanent Agency Details (if temporary or contractual)

Remunerations Rs. 3,70,000 per year Can a reference be taken now? Yes / No - No If no, by which date we can contact them? N/A

Reason(s) for Leaving Resignation due to health reasons

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Optimum Info System Private Limited

Letter of Authorization
I understand that any employment by Optimum Info System Private Limited or its affiliated companies is conditioned upon positive responses from my references, bonding eligibility, continued adherence to Optimum Info System Private Limited policies and procedures, applicable rules and regulations and job performance satisfactory at all times to Optimum Info System Private Limited I consent to take any pre or post-employment examinations as may be required by Optimum Info System Private Limited or its representative, and release Optimum Info System Private Limited from any liability that may arise from such examination. I authorize an inquiry to be made on the information contained on this application. Former employers and officials of education institutes, named on this application are authorized to give information about me and I release them from all liability for issuing such information. I hereby attest and warrant that all my answers on this application as well as on all forms completed in conjunction with my employment are true and accurate. I understand that my misrepresentation of facts, failure to disclose information required on this application or material change in my information provided which is not reported to Human Resources shall be cause for dismissal regardless of when discovered by Optimum Info System Private Limited.

Signed: Name in Block Capitals: Date of Birth: Date:

____________________ SHRINIVAS GANESAN 01-JUNE-1983

22-APRIL-2013

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