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Police Verification Form

This police verification form collects personal information about an individual in 3 sections. Section 1 requests identifying information like name, aliases, addresses, and photo. Section 2 asks about residential history and family details. Section 3 inquires about educational and employment background, criminal history, and character references. The form is signed by the applicant and employer to verify the accuracy of the information provided.

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rohit1409
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2K views2 pages

Police Verification Form

This police verification form collects personal information about an individual in 3 sections. Section 1 requests identifying information like name, aliases, addresses, and photo. Section 2 asks about residential history and family details. Section 3 inquires about educational and employment background, criminal history, and character references. The form is signed by the applicant and employer to verify the accuracy of the information provided.

Uploaded by

rohit1409
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as XLS, PDF, TXT or read online on Scribd
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POLICE VERIFICATION FORM

S. No. Particulars

Full Name with aliases, if any (please indicate if you have added
1
or dropped at any stage any part of the name /surname)

PHOTO
(To Be Pasted)
2 Present address in full, with Police Station & District

3 Home/ Permanent Address in Full with Police Station & District


(Seal)

Particulars of places with periods of residence where you have resided during the preceding 2 years (Verify only Delhi residing period.)

Period
Address in Full with Police Station & District
From To
4

Father's Name in Full With aliases, if any Nationality

5 Occupation (If employed give Present Address Permanent Address


Place of Birth
designation & Office)

6 Applicant's Nationality

7 Date of Birth

8 Two marks of Identification

Education Qualification Showing place of education with years in schools and colleges since 15 years of age

Name of college/ school with full address From To


Examination Passed

High School/ SSC


9

Intermediate

Graduate

Post Graduate
10
Full Name& Address of
Period Designation Nature Of Employment Reason for leaving previous services
Employer/ Organization

11
If the previous employment was under the Govt of India/State Govt

Undertaking owned or controlled by Govt./Autonomous Body

University/Local body, State briefly whether you have been terminated

Removed or dismissed from service on any disciplinary proceedings

Charged or had you been called to explain your conduct in any matter
before or at a subsequent date of your actual termination

Dismissal/ Removal/ Retirement, etc…..

12
Yes No
Have you ever been arrested ?

Yes No
Have you ever been prosecuted ?

Yes No
Have you ever been kept under detention ?

Yes No
Have you ever been bound down ?

Yes No
Have you ever been fined by court of law ?

Yes No
Have you ever been convicted by court of law ?

Yes No
Is any case pending against you in court of law ?

Whether discharged/expelled withdraw from any training institution under Govt. or otherwise ? Yes No

Have you ever been involved in any Police or Criminal Case? Yes No

13
Name & Address of 2 responsible persons other than relatives to whom you are known:

I certify that the above information is correct and complete to the best of my knowledge and belief. I am not aware of any circumstances,
which might impair my services for Commonwealth Games Test Events, Delhi 2010

Counter Signature of Employer/Authorized signatory with stamp Signature of Applicant

Date:

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