Infosys Verification Form – Fill Out and Use This PDF

BACKGROUND VERIFICATION FORM

Infosys employee number:

Candidate ID:

50045060

Infosys Limited

INSTRUCTIONS:

It is mandatory for you to complete the form in all respects

Please provide complete and correct information

BACKGROUND VERIFICATION FORM

Infosys Limited

	Infosys Employee Code			Location		Date Of Joining
			Pune			29-Apr-13
	Candidate ID		50045060
	Personal Information
	Full Name (First, Middle,					Former Name / Maiden Name
	Last)					(if Applicable)
	Bhagwan Balkrishna Keskar
	Father’s Name				Nationality	Date Of Birth	Gender
	Mr. Father				Indian	09-Jul-81	Male
	Social Security Number (if applicable):

Please tick mark the documents submitted for this employment:

Service Certificate	Relieving letter	Offer letter	None	Any Other
Specify:___________________

Previous Employment History (Inclusion of last 5 years of Employment or last two Employers whichever is higher.) Please attach a copy of your relieving letter/service certificate

Note: Ensure that you are descriptive wherever necessary – e.g. If Co. is closed, do mention it. Employee Code/ ID/ Number is mandatory. If your previous employer did not provide one, please mention and state reasons for the same.

Name of Employer(2):			Address of Employer(2):
Accelon Technologies			Test
Telephone No:	Employee Code/No:		Designation:		Department:
1234567898	23345		SAP Consultant		IT
Employment Period:			Manager’s Name:		Manager’s Contact No:
			Mr. Mgr		3456789098
From:	To:				Manager’s Email ID:
15-Feb-07	01-Apr-08				test@test.com
Duties & Responsibilities:			Reasons for leaving:
NA			NA
			Agency Details (if temporary or		Was this Position:
			contractual), provide details:		Perm Full Time
			NA

Please tick mark the documents submitted for this employment:
Service Certificate	Relieving letter	Offer letter	None	Any Other
Specify:___________________

Previous Employment History (Inclusion of last 5 years of Employment or last two Employers whichever is higher.) Please attach a copy of your relieving letter/service certificate

Note: Ensure that you are descriptive wherever necessary – e.g. If Co. is closed, do mention it. Employee Code/ ID/ Number is mandatory. If your previous employer did not provide one, please mention and state reasons for the same.

Name of Employer(3):		Address of Employer(3):
Suzlon Energy Limited		Add Line1
Telephone No:	Employee Code/No:	Designation:	Department:
2345432345	1234	SAPOC PP executive	IT
Employment Period:		Manager’s Name:	Manager’s Contact No:
		Mr. Mgr	3456789098
From:	To:		Manager’s Email ID:
15-Apr-08	01-May-10		test@test.com
Duties & Responsibilities:		Reasons for leaving:
NA		NA

	Agency Details (if temporary or	Was this Position:
	contractual), provide details:	Perm Full Time
	NA

Please tick mark the documents submitted for this employment:
Service Certificate	Relieving letter	Offer letter	None	Any Other
Specify:___________________

Previous Employment History (Inclusion of last 5 years of Employment or last two Employers whichever is higher.) Please attach a copy of your relieving letter/service certificate

Note: Ensure that you are descriptive wherever necessary – e.g. If Co. is closed, do mention it. Employee Code/ ID/ Number is mandatory. If your previous employer did not provide one, please mention and state reasons for the same.

Name of Employer(4):		Address of Employer(4):
Avartha Technologies		Test
Telephone No:	Employee Code/No:	Designation:	Department:
1234567898	34567	Functional Consultant	IT
Employment Period:		Manager’s Name:	Manager’s Contact No:
		Mgr	9876456789
From:	To:		Manager’s Email ID:
15-Jun-10	01-May-11		test@test.com
Duties & Responsibilities:		Reasons for leaving:
NA		NA
		Agency Details (if temporary or	Was this Position:
		contractual), provide details:	Temp Part Time
		NA

Please tick mark the documents submitted for this employment:
Service Certificate	Relieving letter	Offer letter	None	Any Other
Specify:___________________

Previous Employment History (Inclusion of last 5 years of Employment or last two Employers whichever is higher.) Please attach a copy of your relieving letter/service certificate

Note: Ensure that you are descriptive wherever necessary – e.g. If Co. is closed, do mention it. Employee Code/ ID/ Number is mandatory. If your previous employer did not provide one, please mention and state reasons for the same.

Name of Employer(5):		Address of Employer(5):
IBM India Pvt. Ltd		Add Line1
Telephone No:	Employee Code/No:	Designation:	Department:
0923456789	34567	Application Consultant	IT
Employment Period:		Manager’s Name:	Manager’s Contact No:

				Mgr		9089897654
From:		To:				Manager’s Email ID:
15-Jun-11		24-Mar-13				test@test.com
Duties & Responsibilities:				Reasons for leaving:
NA				NA
				Agency Details (if temporary or		Was this Position:
				contractual), provide details:		Perm Full Time
				NA
Please tick mark the documents submitted for this employment:
Service Certificate	Relieving letter		Offer letter	None	Any Other
Specify:___________________
Please account for any and all employment gaps of more than 3 months:
From:		To:		Reason:
Complete Address and Location:
From:		To:		Reason:
Complete Address and Location:
From:		To:		Reason:
Complete Address and Location:

Documents Required

Education:

• Photocopy of degree certificate and all mark sheets or consolidated mark sheet including all semesters/years.

For Bangalore University:

• A photo copy of both sides of Degree Certificate

• Copies of Marks sheet/Grade card for all years of attendance

• Name of college through which candidate has graduated

Employment:

• Photocopy of relieving / experience letter

Letter of Authorization

To whom it may concern

I hereby authorize Infosys Limited (“Infosys”) and any of its representatives (NASSCOM approved Agency) to verify all the information provided in my application of employment and to conduct such enquiries as may be required by Infosys Limited to verify facts of all such information provided by me. I hereby declare that this authorization shall be valid till such time I remain an employee of Infosys.

I hereby authorize all Individuals, Private Establishments, Government Establishments/Agencies; Educational Institutions who may have information relevant to this enquiry to co-operate and disclose to Infosys and/or its representatives such information as may be required. I hereby release Infosys, all its personnel and representatives from any liability which could result, either directly or indirectly, from the disclosure of information by a third party to another party in response to such enquiries.

Signature:

Name in Block Capitals:

Date: