PROFILE BACKGROUND

Please fill all details. Fields marked with * are mandatory.

Note: Please avoid using short forms / abbreviations wherever possible.

CLIENT # :
PERSONAL DETAILS EMPLOYEE ID:
NAME:
*First Name *Middle Name *Last Name/Surname
Jayson Philip

*Standard format of writing the name: Jayson Philip

*Have you ever changed your name? YES ✔NO (Please attach a copy of the name change document)
If YES, name change date: DD/MM/YY
Previous Name(s)/Maiden First Name Middle Name Last Name/Surname
Name (If applicable)

*Father’s name First Name Middle Name Last Name/Surname

Philip Mathew

COMPLETE CURRENT ADDRESS:

*Address: Swapnah Shilpah Bldg 3rd Floor
Period of Stay (DD/MM/YY)
*Landmark:Opposite Metro Green Society Pune *City
*From:
*State: Maharashtra PIN_ 411048
*To:
Landline Telephone Number:
PERMANENT ADDRESS:
*Address: Same as Above
Period of Stay (DD/MM/YY)
*Landmark: *City
*From:
*State: PIN_
*To:
Landline Telephone Number:
*Gender: ✔Male Female Marital Status: Single ✔Married

*Date of Birth: (27/01/1987) *Nationality: Indian

CONTACT DETAILS
*Email: [email protected] *Mobile: 9860110867
*Photo Identification Proof (Attach a copy) *Address Proof (Attach a copy)

 Passport ✔PAN Card  Lease/Rental Agreement Bank Statement

 Driver License Voter ID  Landline Voter ID
 Others
ID NUMBER

Fields marked with * are mandatory Page 1 of 8

 PROFILE BACKGROUND
EDUCATIONAL QUALIFICATIONS
Note: Please attach more educational sheets if necessary
Please fill all degree/educational qualification details and attach necessary documents.

EDUCATIONAL RECORD – MASTER’S DEGREE / HIGHEST DEGREE

(Please attach copy of degree certificates and all year mark sheets)

* College Name: Nowrosjee Wadia College

* College Address: 19 Late Prin Vk Joag Path

City Pune State Maharashtra Country India

Pin Code 411001 Contact Number (Landline) 02026162944

* University Name: Pune University

* University Address: Ganeshkhind Pune 411007

City Pune State Maharastra Country Pune

Pin Code 411007 Contact Number (Landline) 02025696061

* From (month &year) 10/2008 * Graduated * Program * Registration No.
 YES✔  Full Time✔
* To (month & year)
 NO  Part Time
 Distance Edu. Roll No.
P002505
* Degree Name * Subject Major * Graduation Date
Bachlore in Arts (BA) English
Month April Year 2012
* Period of Stay during Education: * Location of Stay during Education:
MM/YYYY to MM/YYYY
* Copy of the Certificate Attached YES✔ NO
* Educated Overseas YES NO✔
If YES, please mention Unique Identification Number at Overseas (SSN/TIN):

Given name at Overseas:

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 PROFILE BACKGROUND
EMPLOYMENT DETAILS
Note: Please attach more employment sheets if necessary.
Please ensure that you are descriptive wherever necessary – For example, if the company no longer exists, acquired,
or merged, please do mention it. Employee Code/ ID/ Number are necessary. If your previous employer did not
provide you one, please mention and provide us with reasons for the same.
DETAILS OF CURRENT EMPLOYER OR LATEST EMPLOYER
Please attach a copy of your Offer letter / Service Certificate
* Company Name: Capita Pvt Ltd

* Main Office Address: Wing C Marisoft, Kalyani Nagar Annex, Wadgaon Sheri Pune

Pin Code 411014 Contact Number (Landline) 02066093535

Website www.capita.co.ij
* Reporting Branch Office Address: Same as Above

Pin Code
JOB DETAILS Contact Number (Landline)

Employment Period: * From 14 / 11 / 2016 * To 26 / 04 / 2017

* Designation: Executive Cs * Department: Webchat

* Employee ID/Code: 10375767 * Employment Type ✔Permanent

Contractual
REPORTING MANAGER’S DETAILS AGENCY NAME & DETAILS (if contractual)

* Name: Rohan Dias * Agency Name:

* Designation: Team Leader * Address:

* Department: Webchat

* Present Contact No:

* Contac No:
* Official Email ID:
* Email ID:
* Reason(s) for Leaving: Personal
* Is this your current employment? YES ✔NO
If YES, mention date when verification can be initiated: DD / MM / YYYY
Any other pertinent information:

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 PROFILE BACKGROUND
DETAILS OF PREVIOUS EMPLOYERS
Please attach a copy of your Relieving letter/Service Certificate
* Company Name:

* Main Office Address:

Pin Code Contact Number (Landline)

Website
* Reporting Branch Office Address:

Pin Code
JOB DETAILS Contact Number (Landline)

Employment Period: * From DD / MM / YYYY * To DD / MM / YYYY

* Designation: * Department:

* Employee ID/Code: * Employment Type Permanent Contractual

* Salary (CTC):
REPORTING MANAGER’S DETAILS AGENCY NAME & DETAILS (if contractual)

* Name: * Agency Name:

* Designation: * Address:

* Department: _

* Present Contact No: * Contact No:

* Official Email ID: * Email ID:

* Reason(s) for Leaving:

* Is this your current employment? YES NO

If YES, mention date when verification can be initiated: DD / MM / YYYY

Any other pertinent information:

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 PROFILE BACKGROUND
DETAILS OF PREVIOUS EMPLOYERS
Please attach a copy of your Relieving letter/Service Certificate
* Company Name:

* Main Office Address:

Pin Code Contact Number (Landline)

Website
* Reporting Branch Office Address:

Pin Code
JOB DETAILS Contact Number (Landline)

Employment Period: * From DD / MM / YYYY * To DD / MM / YYYY

* Designation: * Department:

* Employee ID/Code: * Employment Type Permanent Contractual

* Salary (CTC):
REPORTING MANAGER’S DETAILS AGENCY NAME & DETAILS (if contractual)

* Name: * Agency Name:

* Designation: * Address:

* Department: _

* Present Contact No: * Contact No:

* Official Email ID: * Email ID:

* Reason(s) for Leaving:

* Is this your current employment? YES NO

If YES, mention date when verification can be initiated: DD / MM / YYYY

Any other pertinent information:

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 PROFILE BACKGROUND
UNEMPLOYMENT HISTORY (if any)
Please account for all periods of unemployment for the last five years

* From DD / MM / YYYY * To DD / MM / YYYY * Reason:

* From DD / MM / YYYY * To DD / MM / YYYY * Reason:

* From DD / MM / YYYY * To DD / MM / YYYY * Reason:

PROFESSIONAL REFERENCE DETAILS

Note: Please attach more reference sheets if necessary
Details Reference 1 Reference 2
Leena Dasri
* Reference Full Name
Executive Cs
* Designation
Capita Pvt Ltd
* Company Name
7517768991
* Contact Number
[email protected]
* Company Email Address

* How do you know this person?

 ✔YES  NO  YES  NO
* Can the reference be
contacted? If NO, please give the reason why If NO, please give the reason why
and provide alternate reference and provide alternate reference

 YES  ✔NO  YES  NO

* Is the reference linked to
current employment? If YES, please mention the date If YES, please mention the date
when the reference can be when the reference can be
contacted: contacted:

Additional Information

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 PROFILE BACKGROUND
EMERGENCY CONTACT FORM

MEDICAL INFORMATION

Illness if any : ......................................................NA.....................................................................

...

Current Medication :
..............................................NA................................................................................

Blood group : ............................................B+..................................................................................

Doctor’s Name : ........................................................................................................................... ...

Doctors contact details : ..............................................................................................................................

EMERGENCY CONTACT DETAILS

Contact 1 - Name : ...Leena

Jayson...........................................................................................................................

Relationship : .....Wife......................................................................................................................
...

Contact details :
................................7517768991........................................................................................... ...

Contact 2 - Name : ......Syamala

Philip........................................................................................................................

Relationship : ......................................Mother................................................................................
..... ...

Contact details :
...........................9890843407...................................................................................................

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 PROFILE BACKGROUND

Date 21 / 10 / 2021 Candidate’s Signature Jayson Philip

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 PROFILE BACKGROUND
MANDATORY SUPPORTING DOCUMENTS/INSTRUCTIONS

ADDRESS CHECK  Location details along with 2 landmarks & landline telephone
numbers

 Photocopy of the degree certificate and final year mark sheet

 Registration number or Enrollment Number

Bangalore University Specific

EDUCATION CHECK  Photocopy of both sides of the degree certificate (The reverse
side of the certificate has some information which the
University would require).
 Copies of Mark sheets / Grade Card for all the years of
attendance.

Reg. No., College Name & College contact details are

mandatory.

 Photocopy of Relieving / Experience Certificate of each

employment
 Latest month Salary Slip of each employment
EMPLOYMENT CHECK
Current Employment: Please do not fill details of the company
verifying your background. Please fill latest/last employer’s
information other than for whom you are being verified.

 Details provided must be of the Reporting Manager at the

REFERENCE CHECK previous company. Please provide full name, designation,
landline telephone numbers and official email ID.

 Signed Profile Background Form (First page of this document)

 Passport size photographs – 3
CRIMINAL RECORD CHECK  Photo Identification Proof
 Address Proof
 CID form duly filled and signed ( Where Applicable)

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 PROFILE BACKGROUND
INFORMATION RELEASE FORM / CONSENT

To Whom It May Concern,

I, Philip Jayson
(Last Name) (First Name) (Middle Name)

hereby authorize, cFirst Background Checks LLP and/or any of its subsidiaries or affiliates or partners or
vendors, and any persons or organizations acting on its behalf, to verify information presented on my
employment application and to compile a background report for that purpose. I hereby grant authority
for the bearer of this letter to access or be provided with full details of my previous employment
records held by any company or business for which I previously worked. This information should
include, but not be restricted to, the dates of employment, designation, details of my salary upon
departure and an appraisal of my performance, capabilities and character. I hereby release from
liability, all persons or entities requesting or supplying such information.

Date: 20 / 10 / 2021 Candidate’s Signature

Location: Pune Jayson Philip

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