Professional Documents
Culture Documents
Personal Data Form
Personal Data Form
Personal Data Form
Please affix
Designation Bank Account No PAN No
recent
Photograph
Address History (List most recent first) – Please provide addresses for the last ten years
Period of Stay
Address State Country Zip Code Contact No
From To
2010 RAJ. INDIA 302011 8000095555
2021 HOUSE/
FLAT/PLOT
NO.,STREET/AREA,
CITY
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Educational Qualification (Starting from Secondary)
Dates Attended Year Of
Standard School/College Name Board/University Percentage
From To Passing
CBSE 80
TH
12 ST. TERESSA 2013 2014 2014
Professional Certification -
Dates Attended Type of Qualification
Course Institute Name ID/Roll No
From To Certification Gained
CA/CS ICAI 2018 2021 CA 231654156
Subject Major
Full Time
Part Time
Please tick mark the documents submitted for this qualification along with this form
Marksheet Provisional Certificate Degree Certificate None
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Employment History (List most recent first and covering last 2 employers)- Last Employer
Note: Ensure that you are descriptive wherever necessary- eg. If co. is closed, do mention it. Employee Code/Id/Number
is mandatory. If your previous employer did not provide one, Please mention and state reasons for the same your
Name of Last Employer: SURESH SHARMA Address of Last Employer: SSC LTD., MUMBAI
Employment Period Manager’s Name XYZ Manager’s Contact No 9999999999 Can a reference
taken now?
From 2019 To2021 Manager’s Email Id Yes
manager@gmail.com No
Duties & Responsibilities gdjgjhfhdsfhd Reason for leaving FURTHER GROWTH
First Salary Drawn 30000 Was this Position Agency Details (if temporary or Contractual), provide details
Permanent
Second Salary Drawn 37000 Temporary
Contractual
Please tick mark the documents submitted for this employment
Service Certificate Relieving Letter Offer letter Any Other (please specify) PAYSLIP
None
Previous Employment History (Last 2 employers)- Please attach a copy of your relieving letter/service certificate
Note: Ensure that you are descriptive wherever necessary- eg. If co. is closed, do mention it. Employee Code/Id/Number
is mandatory. If your previous employer did not provide one, Please mention and state reasons for the same your
Name of Employer (1): NA Address of Employer:
First Salary Drawn Was this Position Agency Details (if temporary or Contractual), provide details
Permanent
Second Salary Drawn Temporary
Contractual
Please tick mark the documents submitted for this employment
Service Certificate Relieving Letter Offer letter Any Other (please specify)
None
Previous Employment History (Last 2 employers)- Please attach a copy of your relieving letter/service certificate
Note: Ensure that you are descriptive wherever necessary- eg. If co. is closed, do mention it. Employee Code/Id/Number
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is mandatory. If your previous employer did not provide one, Please mention and state reasons for the same your t
First Salary Drawn Was this Position Agency Details (if temporary or Contractual), provide details
Permanent
Second Salary Drawn Temporary
Contractual
Please tick mark the documents submitted for this employment
Service Certificate Relieving Letter Offer letter Any Other (please specify)
None
Please give details of the vehicle you would be using for commutation:
Have you ever been arrested / summoned by court? If yes, give details.
_______________NA____________________________________________________________
___________________________________________________________________________
Do you hold a valid passport? If yes, then mention your passport number here under
________________________NA___________________________________________________
References (Person should hold responsible position and should not be a relative
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S.No Name Address Occupation Contact No
Please account for any and all gaps in education or employment during your tenure
From NA To Reason:
From To Reason:
From To Reason:
Documents Required:
Education:
Photocopy of degree certificate and final marksheet
Employment
Photocopy of relieving/experience letter
Criminal Verification: Rest of India except Tamil Nadu, Andhra Pradesh and Karnataka
Three (3) passport size photographs
The passport Copy, election Id, Driving License or copy of attested photo passbook 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 provide, in order of priority
a) Utility bills-MTNL or BSES bills stating current address (can not be accepted in rural areas)
b) A copy of the Lease agreement (Rural & Urban)
c) If staying at Company accommodation then Letter from Company is required stating the same.
d) If living with relative/friend, then the agreement copy of the residence and the letter stating the relationship with the concerned
relative/friend. Can submit a letter on the society letterhead as well. (original copy would be required)
e) Completed CID Form (filled in Blue ink)
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.
Note: Your Data can be shared with 3rd party i.e government or private agencies as per the business or legal requirements.
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I hereby authorize NAV Back office (or a third party agent appointed by Company) to contact any former employers as indicated above and carry
out the Background Checks not restricted to education and employment deemed appropriate through this selection procedure. I authorize former
employers, agencies, education institutes etc to release any information pertaining to my employment/education and I release them from any
liability in doing so.
I certify that the above statements are correct and complete to best of my knowledge and belief and nothing has been concealed. I am not aware of
any circumstances which might impair my fitness for employment. If at any time, I am found to have concealed any material information or given
any false details, my appointment should be liable for termination without any notice or compensation and Company is free to take any legal
actions.
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