BACKGROUND CHECK FORM

Name of Candidate Fathers Name Date of Birth Name of Contracting Agency Date of joining Sapient Telephone No. Current Address

Address

:To

Period of stay:- From-

List of Documents Required

1 Education Final semester /final year marksheet + Degree certificate OR Final semester /final year marksheet + Provisional Certificate

Employment 01Immediate Last Company

Appointment letter + Resignation Acceptance letter + 01 Last month Pay slip OR Appointment letter + 01 Last month Pay slip OR

Service certificate / Experience letter

Employment 02Second Last Company

Appointment letter + Relieving letter/Resignation Acceptance letter + 01 Pay slip OR Service certificate / Experience letter

All fields are MANDATORY in this Form

Highest Completed Education Qualification Details: Do not enter pursuing qualification details. Qualification should be minimum of 01 year and above.

Details 1 College Name & Location

Highest Qualification Details

University Name

Qualification Attained

Year of passing

Roll. No/ Registration No./Student ID

Regular / Correspondence

Result ( Pass / Result Awaited)

Employment Details:

Employment details are required for Payroll Company not of Client Company (for example tenure, designation and employee code is required for payroll company). In case you were deputed to client The supervisor name will be the name of Payroll Companys HR.
nd

Details 1 2 Name of the company Employer Address/ Location

Immediate Last company

2 Last company

3 4

Employer landline numbers / HR contact details-with name and no. Period of employment (DD/MM/YY) Full Time Part Time On Contract Freelancer From: To: From: To:

Job Title/ Designation

6 7 8

Supervisor name, designation and contact details Employee code (MANDATORY) If not applicable write - NA Any other Information (e.g., Company shut down/ merged/name changed)

Describe reason for GAP (If any) Between last company and 2 last company Between education completion and joining first companyTo:
nd

From: Reason:

Declaration and Authorization

(PRINT, SIGN, SCAN)

I hereby authorize Sapient (or a third party agent appointed by the Company) to contact any former employers as indicated above and carry out all Background Checks not restricted to education and employment deemed appropriate through this selection procedure. I authorize former employers, agencies, educational institutes etc. to release any information pertaining to my employment/education and I release them from any liability in doing so. I confirm that the above information is correct to the best of my knowledge and I understand that any misrepresentation of information on this application form may, in the event of my obtaining employment, result in action based on company policy. Signature: Name: Date: