Background Verification Form Please Print Clearly and Provide Complete and Accurate Information Full Name (First, Middle, Last) Personal Details (3) Original colour passport size photographs Former Name(s) / Maiden Name (if applicable) Gender: Male Female Date of Birth (dd/mm/yy) Residence Number Father s Name Passport No Current Complete Details of From:(mm/yy) To: (mm/yy) Telephone Number/ Cell Number Permanent
Educational Qualifications Highest Professional Qualification (IMPORTANT: Copy of marksheet and degree certificate MUST be attached) College Name (1) College University Name and From - To Graduated Yes No Program Full Time Part Time Roll No / Enrollment No. Type of degree Graduation date Subject Major Bachelors Degree / Qualification (IMPORTANT: Copy of mark sheet and degree certificate MUST be attached) College Name (1) College University Name and From - To Graduated Yes No Program Full Time Part Time Roll No / Enrollment No. Type of degree Graduation date Subject Major Page 2 of 6
Employment History Details of Current or Last Employer Merrill Lynch (India) Technology Services Private Limited Company Name (1) : Position Held & Department (main office and branch where worked): Telephone: Employment Period: (date, month, year) From To Employee Code: Reported to (Name): Designation: Department: e-mail: Phone Number: Whether employment is of permanent or temporary nature - Permanent Temporary Agency Details (if temporary or contractual) Remunerations Reason(s) for Leaving Can a reference be taken now? Yes / No. If no, when can it be taken? Details of Previous Employers Company Name (2) : Position Held & Department (main office and branch where worked): Telephone: Employment Period: (date, month, year) From To Employee Code: Reported to (Name): Designation: Department: e-mail: Phone Number: Whether employment is of permanent or temporary nature - Permanent Temporary Agency Details (if temporary or contractual) Remunerations Reason(s) for Leaving Page 3 of 6
Letter of Authorization To whom it may concern I understand that Merrill Lynch may use an outside agency to verify and validate the information I have provided including my employment, my personal background, professional standing, work history and qualifications. I understand that an outside background agency may obtain information it deems appropriate from various sources including, but not limited to, the following: current and past employers, criminal conviction records, school records, College records and professional and personal references. I authorize, without reservation, any individual, corporation or other private or public entity to furnish Merrill Lynch and the outside background agency all information about me. I unconditionally release and hold harmless any individual, corporation, or private or public entity from any and all causes of action that might arise from furnishing to Merrill Lynch and the outside agency information that they may request pursuant to this release. This authorization and release, in original, faxed or photocopied form, shall be valid for this and any future reports and updates that may be requested. Signed: Name in Block Capitals: Date: Page 4 of 6
For Education Verification: Documents Required Photocopy of the degree certificate and mark sheet for all the years of attendance would be required. For Bangalore University: A Photo Copy of both the sides of the Degree Certificate (The reverse side of the certificate has some information which the University would require). Copies of the Marks Sheets/Grade Card for all the years of attendance. Name of the College through which the candidate has graduated.) For Employment Verification: Photocopy of relieving certificate For Criminal Background Checks (Mumbai and rest of Maharashtra) (3) Passport size color photographs. The Passport Copy or the Ration Card Copy is mandatory, irrespective of the address (If the current address corresponds to the one in these documents, then no other documents are required. If not corresponding to the current address then the following will have to be provided, in order of priority) - Utility bills - MTNL or BSES Bills stating current address - A copy of the Lease Agreement. - If staying at Company accommodation then Letter from Company is required stating the same. - If living with relative/ friend, then the agreement copy of the residence and letter stating relationship with the concerned relative/friend. Completed CID Form Page 5 of 6
*For Criminal Background Verification As is the procedure followed by most police departments across India for criminal background verification, it is possible that police authorities may contact you or visit your stated residence and at times even ask you to present yourself at the concerned police station. It is part of the standard verification procedure. Please do not give in to any attempts at coercion by the authorities and in the event of an occurrence, please get in touch with us. Page 6 of 6