Fresher’s
BACKGROUND VERIFICATION FORM
Infosys employee number:
Candidate ID: 12655707
Infosys Limited
INSTRUCTIONS:
It is mandatory for you to complete the form in all respects
Please provide complete and correct information
FRESHER’S BACKGROUND VERIFICATION FORM
Infosys Limited
Infosys Employee Code Location Date Of Joining
Mysore 05-Aug-19
Candidate ID 12655707
Personal Information
Full Name (First, Middle, Former Name / Maiden Name
Last) (if Applicable)
Sunil Chaudhary
Father’s Name Nationality Date Of Birth Gender
Pukhraj Chaudhary Indian 25-Dec-97 Male
Social Security Number (if applicable):
Post-Graduation Details
College Name & Address University Name & Date attended Qualification ID/Roll
Gained
Address From To No
Please tick mark the documents submitted for this qualification along with this form Full Time/Part Time
Mark sheet Provisional Certificate Degree Certificate
Graduation details
College Name & Address University Name & Date attended Qualification ID/Roll
Gained
Address From To No
Sreenidhi Institute of Science J.N.T. UNIVERSITY 01-Aug- 01-May- Bachelor 15311A19A7
and Technology 15 19 Of
Technology
Please tick mark the documents submitted for this qualification along with this form Full Time/Part Time
Full Time
Mark sheet Provisional Certificate Degree Certificate
Please account for any and all gaps of more than 3 months between last education and first
employment:
From: To: Reason:
Complete Address and Location:
Previous Employment History (Inclusion of last 3 Employers if any ) 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(1): Address of Employer(1):
Telephone No: Employee Code/No: Designation:
Employment Period: Manager’s Name: Manager’s Contact No:
From: To: Manager’s Email ID:
Agency Details (if temporary or contractual), provide details: Reasons for leaving:
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 3 Employers if any ) 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):
Telephone No: Employee Code/No: Designation:
Employment Period: Manager’s Name: Manager’s Contact No:
From: To: Manager’s Email ID:
Agency Details (if temporary or contractual), provide details: Reasons for leaving:
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 3 Employers if any ) 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):
Telephone No: Employee Code/No: Designation:
Employment Period: Manager’s Name(optional): Manager’s Contact
No(optional):
From: To: Manager’s Email ID(optional):
Agency Details (if temporary or contractual), provide details: Reasons for leaving:
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 gaps of more than 3 months between last education and first
employment:
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
ADDRESS DETAILS
Current Address
Period of stay (mm-yyyy) Address State Country Zip/ Contact
PinCode
From To Number
408,Indra Rajasthan India 306401 6377120299
colony
,Pali,
Rajasthan
Permanent
Address
Period of stay (mm-yyyy) Address State Country Zip/ Contact Number
PinCode
From To
408,Indra Rajasthan India 306401 6377120299
colony
,Pali,
Rajasthan
Address History (List most recent first) - Please provide addresses for the last three years (03 years)
Period of stay (mm-yyyy) Address State Country Zip/ Contact Number
PinCode
From To
01-Dec-97 01-Jan-00 408,Indra Rajasthan India 306401 6377120299
colony ,Pali,
Rajasthan,Pali,
pali,306401
**Please be informed that you might receive the call from local Police Station for address verification.
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:
Employee Number:
