Candidate Declaration Form

Candidate Declaration Form
VFG/HR/ CDF Ver. No. 3 W.E.F: 16/FEB/2016
Instructions: Please provide all the information requested in this form. Incomplete Candidate
Declaration Forms (CDFs) will be returned. All supporting documents must accompany this form.
Photocopies must be legible. We have included a checklist to assist you to complete your
application comprehensively.
PERSONAL DETAILS
Full Name (First/Middle/Last): ______________________________________________________
Fathers Name/Husband’s Name: _____________________________________________________
Date of birth (DD/MM/YY):_______________ Contact Number: ________________________Nationality: _____________
Passport Number: __________________Date of issue: _____________________Date of expiry: _________________
PAN Number: _________________________________ Blood Group: __________________
Change of Name if Applicable
Former Name/Maiden Name _________________________________
Date of Name Change ___________________________
Current Address Permanent Address
Door No/Street:___________________ Door No/Street: ___________________

City:_____________________________________ City:________________________________________
State:____________________________________ State:______________________________________
Pin:_____________________________________ Pin:________________________________________
Landmark:________________________________ Landmark:___________________________________
Period of stay_____________________________ Period of stay________________________________
Landline/Mobile No._____________________________ Landline/Mobile No._____________________________
Is your residence own or a rented place? ___________ Is your residence own or not? _________________
If rented, please provide details of the Landlord Name: If Not, please provide details of the Landlord
___________________________________ Name: ___________________________________
Address: _________________________________ Address: _________________________________
City: _____________________________________ City: _____________________________________
State: ___________________________________ State: ___________________________________
Pin: __________________________ Pin: __________________________
Landline/Mobile No._____________________________ Landline/Mobile No._____________________________
Proof of Address: (Photocopy of Passport / Last Paid Land Line/Mobile Phone Bill/ Bank Account Statement/
Rent Agreement Copy/Driving License/ National Identity Cards )
For Internal Use Only

VFG ID: ___________________ (To be entered by Verifacts personnel only)
Page | 1
EDUCATION DETAILS
Client Requirements
A: High School
Name of the Course SSC
Student ID No: / Enrolment No: 0929140128 Year of Completion 2009
Subjects ( Arts / Science) Division / Class FIRST
Name of Examining Board BOARD OF SECONDARY EDUCATION TELANGANA
School Name ZILLA PARISHAD HIGH SCHOOL
School Address
City: State: TELANGANA
Pin:  (Landline)
:
B: Higher Secondary (10+2)
Name of the Course
Student ID No: / Enrolment No Duration of Study
Division / Class Degree Obtained
Subject Major Course Type
(Regular/Distance)
Name of Examining Board
School Name
School Address
City: State:
Pin: :(Landline)
: (Email ID)
C: Graduation
Name of the Course
(Regular/Distance
Name of University
Name of College/Study Centre
Address of Institution
City: State:
Pin: :(Landline)
: (Email ID)
D: Post Graduation
Name of the Course
Student ID No:/ Enrolment No Duration of Study
(Regular/Distance
Name of University
City: State:
Pin: :(Landline)
: (Email ID)
E: Any other Technical/ Management

Course
Name of the Course

(Regular/Distance
Name of University
City: State:
Pin: :(Landline)
: (Email ID)
Note: Please attach legible photocopies of the following documents relevant to the entries above
1) Mark sheets of all semesters/years 2) Degree Certificates, FRONT and BACK

3) Provisional Certificate 4) School Leaving Certificate
EMPLOYMENT
NOTE: There are two categories in each form. Please provide information under the relevant Employment Category.
(EMP-1) Current Employment

PERMANENT EMPLOYMENT
Name of Company
Where were you employed?  Registered Corporate  Branch Office
Office
Company Address Door No/Street
(Where you were employed ) City State
Pin  (Landline)
Period of employment Employee Code
Designation Remuneration
Department Reported to
Supervisor’s Designation  (Email Id)
Reason for Leaving
CONTRACTUAL EMPLOYMENT
Company Name
City State
Company Contact Person  (Email Id)
Designation  (Landline)
State you reason for leaving
Page | 3
Can a reference be taken

 Yes  No
now?
If No, when can it be taken?
Note: Please attach legible Photo copies of the following documents relevant to the entries above
Appointment Letter, Salary slips and Release Letter / Service certificate
(EMP-2) Previous Employment

Name of Company
Office
(Where you were employed) City State
Pin  (Landline)
Reason for Leaving
Company Name
City State
Please state your reason for leaving
(EMP-3) Previous Employment

Name of Company
Office
(Where you were employed ) City State
Pin  (Landline)
Reason for Leaving
Company Name
City State
Please state your reason for leaving
References:
Academic References:
Ref 1:
Name and Address
Of Institution
Name of Referee Designation
(Landline) Mobile  (Email Id)
Ref 2:
Name and Address
Of Institution
Name of Referee Designation
Professional References:
Page | 5
Ref 1:
Name
Company/Designation
Ref 2:
Name
Company/Designation
Ref 3:
Name
Company/Designation
Ref 4:
Name
Company/Designation
Other Details
Are you currently under service agreement / bond with your existing employer? (Yes/No)
Have you ever been charged or convicted for any criminal offense in India or abroad? (Yes/No)
Authorization/ Declaration and Undertaking
If employed by <Verifacts Services Pvt Ltd>, I agree to provide copies of all relevant certificates. I understand that employment
with <Verifacts Services Pvt Ltd> is governed by their employment policies as applicable, including satisfactory information
from background checks.
I hereby certify that all information provided herein, is true and complete to the best of my knowledge and belief. I authorize
<Verifacts Services Pvt Ltd> and its representative to authenticate information I have provided in my resume and this
Candidate Declaration Form (CDF). To conduct enquiries as may be necessary at the company’s discretion, I authorize all who
may have information relevant to this enquiry to disclose it to <Verifacts Services Pvt Ltd> and/or its representative. I release all
concerned from any liability on account of such disclosures.
I also declare that the information provided by me in my resume and application for employment to <> and its representative is
authentic and I am liable for all inaccuracies and omissions.
I promise to extend total co-operation and provide relevant documents required.
Full Name of the Candidate: ___________________________________ Signature of the Candidate
Place: ____________________________________________________
Date: _____________________________________________________
Checklist for Candidates

Page | 7
Note: This checklist is to assist you. Please go through all the columns.
Personal Details Addresses

Current Add. Permanent Add.
Fathers’ Name Yes No Pin Code Yes No Pin Code Yes No
Your Date of Birth Yes No Landmark Yes No Landmark Yes No
Your Passport Details Yes NA Landline No Yes No Landline  No Yes No
Mobile number Yes No NA Landlords Name Yes No Neighbours, Name Yes No
SSN/Other Country Nos. Yes No NA LandlordsNo Yes No Neighbours, No Yes No
Personal Contact  No. Yes No NA Last Electricity Bill Yes No Last Electricity Bill Yes No
Date of Name Change Yes No NA Last Phone bill Yes No Last Phone bill Yes No
Education
High School Higher Secondary Graduation Post Graduation
Student Id/Enrolment No. Yes No NA Yes No NA Yes No NA Yes No NA
School/College Name Yes No NA Yes No NA Yes No NA Yes No NA
Location Yes No NA Yes No NA Yes No NA Yes No NA
University/ Institution Name Yes No NA Yes No NA Yes No NA Yes No NA
Mark sheets Yes No NA Yes No NA Yes No NA Yes No NA
Provisional Certificates Yes No NA Yes No NA Yes No NA Yes No NA
Degree Certificates Yes No NA Yes No NA Yes No NA Yes No NA
Yes No NA Yes No NA Yes No NA Yes No NA
Employment
Emp 1 Emp – 2 Emp -3 Emp - 4
Name of Company Yes No NA Yes No NA Yes No NA Yes No NA
Location Yes No NA Yes No NA Yes No NA Yes No NA
Company Contact Nos. Yes No NA Yes No NA Yes No NA Yes No NA
Employee Code Yes No NA Yes No NA Yes No NA Yes No NA
Period of Employment Yes No NA Yes No NA Yes No NA Yes No NA
Appointment Letter Yes No NA Yes No NA Yes No NA Yes No NA
Relieving Letter Yes No NA Yes No NA Yes No NA Yes No NA
Accurate Remuneration Yes No NA Yes No NA Yes No NA Yes No NA
Person Reporting to/Name/No Yes No NA Yes No NA Yes No NA Yes No NA
Authorization
Name Yes No
Place Yes No
Date Yes No
Signature Yes No

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Candidate Declaration Form

VFG/HR/ CDF Ver. No. 3 W.E.F: 16/FEB/2016

Full Name (First/Middle/Last): ______________________________________________________

Fathers Name/Husband’s Name: _____________________________________________________

Date of birth (DD/MM/YY):_______________ Contact Number: ________________________Nationality: _____________

Passport Number: __________________Date of issue: _____________________Date of expiry: _________________

PAN Number: _________________________________ Blood Group: __________________

Change of Name if Applicable

Former Name/Maiden Name _________________________________

Date of Name Change ___________________________

Current Address Permanent Address

Door No/Street:___________________ Door No/Street: ___________________

For Internal Use Only

E: Any other Technical/ Management

Name of the Course

1) Mark sheets of all semesters/years 2) Degree Certificates, FRONT and BACK

(EMP-1) Current Employment

Can a reference be taken

(EMP-2) Previous Employment

(EMP-3) Previous Employment

Authorization/ Declaration and Undertaking

I promise to extend total co-operation and provide relevant documents required.

Full Name of the Candidate: ___________________________________ Signature of the Candidate

Checklist for Candidates

Personal Details Addresses

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Date of birth (DD/MM/YY):___ Contact Number: Nationality: _

Passport Number: ________Date of issue: _Date of expiry: _______

PAN Number: _______________ Blood Group:

Door No/Street:_ Door No/Street: _