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Pre-Employment Verification Form

Employee Code

Employee Location

PERSONAL DETAILS
Name of Applicant
Surname
Middle
First
Date of Birth (dd/mm/yy)

Place of Birth

Sex

Nationality

Fathers Name

Passport No.

Home Phone

Office Phone

Mobile

RESIDENTIAL ADDRESS
Permanent Address

City

State

Pin

Phone No.

Residing Since( Mandatory)

Nature Of Location:
Rented/Owned/Others

Current Address

City

State

Pin

Phone No.

Residing Since(Mandatory)

Nature of Location
Rented/Owned/Others

EDUCATION RECORD

EDUCATION RECORD (Kindly start with the latest/ highest qualification; please attach
photocopies of the documents ) All fields are mandatory
Applicants Name(As mentioned
on the graduation/degree
certificate)
Type of Degree/Diploma
obtained.
State F for fulltime and P for
part-time to be added within
brackets
Name & location of
School/College/Institute

Name & location of University its


affiliated

Dates Attended

From
Date:

To
Date:

Degree / Diploma
(Completed /Pursuing)

Year Of
Passing:
(MM/YYY
Y)

Student ID
Roll Number/Registration
Number/Exam Seat
number/Enrollment Number
Note: Many academic institutions maintain student files by either "Registration", "Student ID", "Roll"
or "Enrollment Numbers etc. You are requested to provide such number in the listed Student ID Field, its
mandatory.

EDUCATION RECORD

EDUCATION RECORD (Kindly start with the latest/ highest qualification; please attach
photocopies of the documents ) All fields are mandatory
Applicants Name(As mentioned
on the graduation/degree
certificate)
Type of Degree/Diploma
obtained.
State F for fulltime and P for
part-time to be added within
brackets
Name & location of
School/College/Institute

Name & location of University its


affiliated

Dates Attended

From
Date:

To
Date:

Degree / Diploma
(Completed /Pursuing)

Year Of
Passing:
(MM/YYY
Y)

Student ID
Roll Number/Registration
Number/Exam Seat
number/Enrollment Number
Note: Many academic institutions maintain student files by either "Registration", "Student ID", "Roll"
or "Enrollment Numbers etc. You are requested to provide such number in the listed Student ID Field, its
mandatory.

EMPLOYMENT RECORD
Employer 1

Employee ID

Full Name

(Mandatory)

Address/Branch

City

From (mm/yy)

To (mm/yy)
(If currently employed,
please mention your
last working day)

Phone Number

State

Country

Postal Code

Reason for Leaving:


Designation

Final Salary (Annual)

Supervisor Name & Title

HR Manager Name

Supervisor s Phone Number(Mandatory)

HR Manager Phone Number(Mandatory)

Direct #:

Direct #:

Extn #:

Extn #:

Mobile #:

Mobile #:

EMPLOYMENT RECORD
Employer 2

Employee
ID

Full Name

Address/Branch

City

From (mm/yy)

To (mm/yy)

Phone Number

State

Country

Postal Code

Job Title

Reason of Leaving

Designation

Final Salary (Annual)

Supervisor Name & Title

HR Manager Name

Supervisor s Phone Number

HR Manager Phone Number

EMPLOYMENT RECORD
Employer 3

Employee
ID

Full Name

Address/Branch

City

From (mm/yy)

Phone Number

State

Country

Postal Code

Job Title

Reason of Leaving

Designation

Final Salary (Annual)

Supervisor Name & Title

HR Manager Name

Supervisor s Phone Number

HR Manager Phone Number

To (mm/yy)

REFERENCE DETAILS - 1
Full name of the Reference
Telephone no
Organization
Relationship with the candidate

REFERENCE DETAILS - 2
Full name of the Reference
Telephone no
Organization
Relationship with the candidate

Information Release Form

To Whom It May Concern:


Please print

I
Last name

First name

Middle name

I hereby authorise KPMG or their representatives to verify information presented on my


employment application/resume and to procure an investigative report or consumer report for
that purpose.
I hereby grant authority for the bearer of this letter to access or be provided with full details

of my previous employment record held by any company or business for whom I


previously worked. This information should include the dates of employment; the
nature of the position held, [details of my salary upon departure] and an appraisal of
my performance, capabilities and character. 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.

of my qualification/degree (copy of my certificates attached)

information in respect to my character from the records maintained by local


authorities

Signature:

Date: dd / mm / yyyy

Have you ever been known by another name?

YES

NO

Checklist
A Address Proofs for Current and Permanent address
2 Photograph
E Education Certificates
E Employment Reliving Letters
Employee Code

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