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Reference Check

1. This document is a reference check form that collects personal and employment details to verify an applicant's background. 2. It requests information such as name, date of birth, address, educational qualifications, employment history including past and present employers, salary, and supervisors' contact details. 3. The applicant must authorize the company to conduct reference checks and acknowledges that incorrect information provided could result in termination.

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mdkumarz4526
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91 views2 pages

Reference Check

1. This document is a reference check form that collects personal and employment details to verify an applicant's background. 2. It requests information such as name, date of birth, address, educational qualifications, employment history including past and present employers, salary, and supervisors' contact details. 3. The applicant must authorize the company to conduct reference checks and acknowledges that incorrect information provided could result in termination.

Uploaded by

mdkumarz4526
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 PDF, TXT or read online on Scribd
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Please affix a

passport size
Reference Check Form photograph here
and sign across.
Personal and Confidential

Instructions:
• Form is to be filled in Block letters.
• All fields are Mandatory, where ever Not Applicable Please specify (NA)/strike out.
• Kindly furnish all details correctly; the verification will be conducted on the basis of
details stated.

A. Personal Details:

1. Full Name: …………………………………………………………………………

2. Date of Birth: …/…/… (mm/dd/yyyy) 3. Gender: Male/Female

4. Marital Status: Married/Single/Others 5. Pan No:……………...

6. Email id (personal): ………………………………………………………………...

B. Address:

Current Address Permanent Address (if not same)

Pin Code: Pin Code:


Contact No: Contact No:
Residential/Mobile Residential/Mobile

B. Educational Qualification: (Starting from the highest)

Qualification Institute-University/Board Year of Grade Full/Part Time/


passing /Percent Correspondence
10th

12th

Graduation

Post Graduation
Professional
Degree

th
RGICL / HR – Reference Check Form / Ver 1.0 /11 Nov. 2009
C. Employment History: (Present Employment)

1. Name of Present Employer: ……………………………………………………...

2. Employee Code: ………..

3. Period of Employment: From: ……… (Mm/dd/yy) Till Date

4. Last Drawn CTC: …………………………………………………………………..

5. Reporting To:
a) Name & Designation: ……………………………………………………...
b) Contact No. & Email id: …………………………………………………...

6. HR Representative:
a) Name & Designation: ……………………………………………………...
b) Contact No. & Email id: …………………………………………………...

D. Employment History: (Previous Employment)

Period of Employment
Name of the Organisation From (mm/dd/yy) To (mm/dd/yy)

AUTHORIZATION NOTE

1. I authorize Reliance General Insurance Co. Ltd. to conduct reference check for the
above mentioned details provided by me post my joining them.

2. I acknowledge that if any of the above information provided by me on post joining is


found untrue or incorrect, this may result in my employment being terminated without notice.

Signature: …………………….. Name:……………………………

Date: …………………….. Place: ……………………………

th
RGICL / HR – Reference Check Form / Ver 1.0 /11 Nov. 2009

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