BACKGROUND INVESTIGATION FORM
Please fill all information in PRINTED. If item is not applicable put “N/A”
CANDIDATE’S DETAILS
Applicant's Name:
Surname Given Name Complete Middle Name Suffix (Jr./Sr/ III,etc)
Civil Status: Gender: Birth Date: (MM/DD/YYYY)
Contact Number: Email Address:
SSS Number: Philhealth Number:
Pag-ibig Number: Tax Identification Number:
Current Address:
Permanent Address:
ADDRESS CHECK
Please provide a sketch of your current address
EMERGENCY CONTACT PERSON:
Contact 1: Relationship: Contact Number:
Contact 2: Relationship: Contact Number:
RELATIVES WORKING IN CONCENTRIX:
Name Relationship Position
Rev 07.09.2020
BACKGROUND INVESTIGATION
AUTHORIZATION FOR EDUCATION CHECK
To the Registrar's Office
To whom it may concern:
This is to authorize confirmation and verification of Concentrix, through their official representative, on
my education records based on my declared information below:
Highest Education Attainment:
O Post-Graduate Degree (Doctorate, Masters) O High School Graduate (ALS passer OR old curriculum)
O Post-Graduate Level (Doctorate, Masters) O Senior High School Graduate (K-12)
O College Graduate O K-12
st
Undergraduate O 1 year College (Completed OR With back subjects)
O 2nd year College (Completed OR With back subjects)
O 3rd year College (Completed OR With back subjects)
O 4th year College (Completed OR With back subjects)
O Diploma/ Associate/ Vocational Course (specify # of year/s )
Name of Institution (College/Post Graduate):
Address / Branch: _
Contact Details:
Name in school records: _
Degree/Course: _
Date of Graduation (if applicable - for College Graduate only) MM/DD/YYYY: _/_ / _
Student ID: _
Dates Attended: From: _/ /_ _To: /_ /
MM / DD / YYYY MM / DD / YYYY
Name of Institution (High School):
Address / Branch:
Contact Details:
Name in school records: _
Date of Graduation (if applicable - for High School Graduate only) MM/DD/YYYY: / /
Student ID: _ Section:
Dates Attended: From: / / To: / _/_
MM / DD / YYYY MM / DD / YYYY
Kindly extend due courtesy upon request of relevant information deemed necessary in completion of
the education checks.
Thank you.
/
Signature over Printed
Name / Date Signed
EMPLOYMENT HISTORY DETAILS
1. NAME OF ORGANIZATION:
ADDRESS:
EMPLOYMENT DATE From (MM/DD/YYYY): / / To (MM/DD/YYYY): / /
POSITION (Upon hiring): POSITION (Upon leaving):
NATURE OF EMPLOYMENT: □ Full-Time □ Part-Time □ Self-Employed □ Internship
IMMEDIATE SUPERVISOR: CONTACT NUMBER:
Reason for Leaving: Recruiter Remarks (R/O):
2. NAME OF ORGANIZATION:
ADDRESS:
EMPLOYMENT DATE From (MM/DD/YYYY): / / To (MM/DD/YYYY): / /
POSITION (Upon hiring): POSITION (Upon leaving):
NATURE OF EMPLOYMENT: □ Full-Time □ Part-Time □ Self-Employed □ Internship
IMMEDIATE SUPERVISOR: CONTACT NUMBER:
Reason for Leaving: Recruiter Remarks (R/O):
3. NAME OF ORGANIZATION:
ADDRESS:
EMPLOYMENT DATE From (MM/DD/YYYY): / / To (MM/DD/YYYY): / /
POSITION (Upon hiring): POSITION (Upon leaving):
NATURE OF EMPLOYMENT: □ Full-Time □ Part-Time □ Self-Employed □ Internship
IMMEDIATE SUPERVISOR: CONTACT NUMBER:
Reason for Leaving: Recruiter Remarks (R/O):
4. NAME OF ORGANIZATION:
ADDRESS:
EMPLOYMENT DATE From (MM/DD/YYYY): / / To (MM/DD/YYYY): / /
POSITION (Upon hiring): POSITION (Upon leaving):
NATURE OF EMPLOYMENT: □ Full-Time □ Part-Time
□ Self-Employed □ Internship IMMEDIATE
SUPERVISOR: CONTACT NUMBER:
Reason for Leaving: Recruiter Remarks (R/O):
5. NAME OF ORGANIZATION:
ADDRESS:
EMPLOYMENT DATE From (MM/DD/YYYY): / / To (MM/DD/YYYY): / /
POSITION (Upon hiring): POSITION (Upon leaving):
NATURE OF EMPLOYMENT: □ Full-Time □ Part-Time □ Self-Employed □ Internship
IMMEDIATE SUPERVISOR: CONTACT NUMBER:
Reason for Leaving: Recruiter Remarks (R/O):
NOTE: If you have more than 5 employment history, please ask the Front
desk/Recruiter to provide another sheet of employment history details.
