(2) Original color

passport size
photographs

Employee Verification Form (Kindly mention full

name at the back of
the photograph)

Applicant No/ Client Reference Entity

Designation
Employee ID Number
GGIT 
GGIT – USA 
KFIT 
DSC 
JPMC New 

 Please provide complete and correct information.

 All fields are mandatory.
 Please do not use short forms / abbreviations.
 Please refer to page 12 for documents & information required

Personal Details

Title (Mr. / Mrs. / Ms.)

Last name First name Middle name

Nationality
Date of Birth
(yy/mm/dd)

Place of Birth

US Social Security Number

(If applicable)

Marital Status:
Gender:
Contact Telephone No.
Office Tele No. Mobile / Pager Email Address
Family Details

Name of Father: (Last name) (First name) (Middle name)

Address: Contact Telephone No. ( )

Next of Kin: (Last name) (First name) (Middle name)

Address: Contact Telephone No.( )

Passport Details If applied for one

Do you have a valid Passport? File number in passport application:

Yes  No  ___________________________

Passport number:

Name as in passport

Date of Birth (yyyy/mm/dd)

Place of residence (if shown)

Date of issue (yyyy/mm/dd)

Place of issue

Expiry date (yyyy/mm/dd)

2
Identity Details

Primary Documents to be attached (Any two)

Passport Number: Date of expiry:

Driving License Number: Date of expiry:

PAN Card Number: Place of issue:

Election ID card Number: Place of issue:

Secondary Documents to be attached if primary documents are not available

Marriage Certificate
Number: Place of issue:

Secondary School Leaving

Certification
Seat Number: Year of passing

Birth Certificate Number: Place of issue:

Notarized affidavit
(with photo, fathers name &
occupation, residence
address and citizenship)

3
Address Details

Current Residential
Address

Prominent Landmark

Contact Details Res. Number: Mobile Number:

Exact period of stay at
current address From: To:
Kindly indicate a
convenient time for a
physical address
verification
Previous Addresses (Covering last 5 years)

Previous Address 1

Landmark

Period of Stay From: To:

Contact Details Res. Number: Mobile Number:

Previous Address 1

Landmark

Period of Stay From: To:

Contact Details Res. Number: Mobile Number:

Previous Address 1

Landmark

Period of Stay From: To:

Contact Details Res. Number: Mobile Number:

Previous Address 1

Landmark

Period of Stay From: To:

Contact Details Res. Number: Mobile Number:

4
Education Details

Highest Educational Qualification

Please ensure copy of degree certificate and mark sheet are attached

Name of the University

College Name

University Address

College Address

From To Graduated Program % / Class Student ID

(month/yr) (month/yr) No./Enrolment No.

 Full Time

 Part Time

Type of degree, certificate, Graduation date (month/yr) Subject Major

diploma:

Copy of the certificates attached?

5
Employment Details

Details of current / latest employer

(In descending order covering last 5 years)

Company Position Held
Name:
(1) & Department

Address (main office where worked): Telephone:

Employment Period: (date, month, year) Employee Code: Supervisor’s Full Name

Designation:
From: DD/MM/YY
Off no. Ext:
To: DD/MM/YY Cell no.
Res no.

Whether employment is of permanent or temporary nature -

 Permanent  Temporary

Agency Details (if temporary or contractual)

Address:

Responsibilities:

Last salary drawn per month Reason(s) for Leaving:

CTC : per month

Gross : per month
Net : per month
Can a reference be taken now? Yes / No

If no, when can it be taken?

** Fill in as much detail as possible and attach all documents.

6
Details of Previous Employer (2)
Company Position Held
Name:
& Department

Address (main office where worked): Telephone:

Employment Period: (date, month, year) Employee Supervisor’s Full Name

Code:
Designation:
From: DD/MM/YY
Off no. Ext:
To: DD/MM/YY Cell no.
Res no.

Whether employment is of permanent or temporary nature -

 Permanent  Temporary

Agency Details (if temporary or contractual)

Responsibilities:

Last salary drawn Reason(s) for Leaving:

CTC : per month

Gross : per month
Net : per month

** Fill in as much detail as possible and attach all documents.

7
Details of Previous Employer (3)
Company Position Held
Name:
& Department

Address (main office where worked): Telephone:

Employment Period: (date, month, year) Employee Supervisor’s Full Name

Code:
Designation:
From: DD/MM/YY
Off no. Ext:
To: DD/MM/YY Cell no.
Res no.

Whether employment is of permanent or temporary nature -

 Permanent  Temporary

Agency Details (if temporary or contractual)

Responsibilities:

Last salary drawn Reason(s) for Leaving:

CTC : per month

Gross : per month
Net : per month

** Fill in as much detail as possible and attach all documents.

8
Details of Previous Employer (4)

Company Position Held

Name:
& Department

Address (main office where worked): Telephone:

Employment Period: (date, month, year) Employee Supervisor’s Full Name

Code:
Designation:
From: DD/MM/YY
Off no. Ext:
To: DD/MM/YY Cell no.
Res no.
Whether employment is of permanent or temporary nature -
 Permanent  Temporary

Agency Details (if temporary or contractual)

Responsibilities:

Last salary drawn Reason(s) for Leaving:

CTC : per month

Gross : per month
Net : per month

** Fill in as much detail as possible and attach all documents.

9
GAPS

Please account for all gaps in employment during the last five years.

From To Reason:

From To Reason:

From To Reason:

10
Letter of Authorization

To whom it may concern

I hereby authorize MphasiS and its representative to verify information provided in my

resume and application of employment, and to conduct enquiries as may be necessary,
at the company's discretion. I authorize all persons who may have information relevant
to this enquiry to disclose it to MphasiS or its representative. I release all persons from
liability on account of such disclosure.

Sign :

Name in Capitals :

Date :

11
Mandatory Documents \ information required:

For Education Verification:

1. Copies of the Marks Sheets/Grade Card for all the years of attendance.
2. A photocopy of both the sides of the Degree Certificate (The reverse side of the
certificate has information which the University requires).
3. Name and address of the College \ University through which the candidate has
graduated.

For Employment Verification

1. Complete name of the employer along with the address and

contact numbers
2. Employee code
3. Supervisor full name, designation and direct contact numbers
4. Relieving letter / Experience Letter / Service Certificate

For Identity Verification:

Photocopies of Primary Documents (Minimum of two – Passport is mandatory and the

other one is any one of Election ID, Driving License or PAN Card)

1. Current Passport copies – first & last sheet. Also, copies of other sheets (if any
stamping is there)
2. Election ID card
3. Driving License
4. PAN Card

Secondary Documents: (If primary documents not available)

1. Birth Certificate
2. Marriage Certificate (if applicable)
3. Last 2 months Bank Statement
4. Last 2 months Credit Card Statement

For Address Verification:

1. Complete address to include, house number - lane number (where applicable), town,
district, state, pin code number, etc.
2. Prominent landmark
3. Land line number
4. Period of Stay

Original color photographs (2 numbers)

Current address proof (passport copy, electricity bill, telephone bill,

Credit card statement, PAN card)
For Criminal Verification refer to the list provided by HR.

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