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    Police Verification For Domestic Servant

    Uploaded by

    Anupam Gupta
    This document contains a domestic servant/employee verification form with various sections seeking details about the servant/employee, their physical description and identification marks, previous employment history, references and contacts, and sections for police verification including fingerprint collection. The employer and police must fill out various sections to verify information provided about the domestic servant/employee.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as DOC, PDF, TXT or read online from Scribd

    Police Verification For Domestic Servant

    Uploaded by

    Anupam Gupta
    3K views7 pages
    This document contains a domestic servant/employee verification form with various sections seeking details about the servant/employee, their physical description and identification marks, previous employment history, references and contacts, and sections for police verification including fingerprint collection. The employer and police must fill out various sections to verify information provided about the domestic servant/employee.

    Original Description:

    Police Verification

    Original Title

    Police Verification for Domestic Servant

    Copyright

    © Attribution Non-Commercial (BY-NC)

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    This document contains a domestic servant/employee verification form with various sections seeking details about the servant/employee, their physical description and identification marks, previous employment history, references and contacts, and sections for police verification including fingerprint collection. The employer and police must fill out various sections to verify information provided about the domestic servant/employee.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as DOC, PDF, TXT or read online from Scribd
    Download as doc, pdf, or txt
    3K views7 pages

    Police Verification For Domestic Servant

    Uploaded by

    Anupam Gupta
    This document contains a domestic servant/employee verification form with various sections seeking details about the servant/employee, their physical description and identification marks, previous employment history, references and contacts, and sections for police verification including fingerprint collection. The employer and police must fill out various sections to verify information provided about the domestic servant/employee.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as DOC, PDF, TXT or read online from Scribd
    Download as doc, pdf, or txt
    You are on page 1of 7

    DOMESTIC SERVANT/EMPLOYEE VERIFICATION FORM

    PART I
    SL. No. ____________POLICE STATION _______________ DISTRICT __________
    DETAILS OF SERVANT/EMPLOYEE
    1. Name of the Servant/Employee (with alias, if any)
    _______________________________________
    2. Fathers Name ___________________________________________________
    3. Mothers Name __________________________________________________
    4. Place & Date of Birth _____________________________________________

    Photograph of
    Servant/Employee

    5. Language spoken ________________________________________________


    6. Permanent Address
    __________________Vill.___________________________________________
    PO___________________ P.S_________________________ District _____________________
    State ____________________Country ____________________
    Tel._______________________
    7. Details of identification proof like Ration Card/Driving Licence/I.Card, if any _______________
    _______________________________________________________________________________
    8. Name & Address of the Sarpanch

    _________________________________________________

    ______________________________________________________________________________
    9. Local Address _________________________________________________________________
    ______________________________________________________________________________
    10. Name & address of previous employer in Delhi
    __________________________________________
    ___________________________________________________________Tel. No. ____________
    11. Date since when employed
    __________________________________________________________

    12. A specialization obtained in which area of domestic help like :(i)

    Cooking ________________________________________________________________

    (ii)

    Dusting & Utensil cleaning _________________________________________________

    (iii)

    Outdoor works ___________________________________________________________

    (iv)

    Attending guest/visitors ____________________________________________________

    (v)

    Attending phone calls _____________________________________________________

    (vi)

    Any other (Please specify) __________________________________________________

    13. DESCRIPTION OF EMPLOYEE


    (i) Height ___________ (ii) Built _____________________________(iii) Eyes ________________
    (iv) Hairs ____________ (v) Complexion _______________(vi) Tatoo Marks __________________
    (vii)

    Other identification Marks _________________________________________________

    (viii)

    Deformity or peculiarity if any _______________________________________________

    (ix)Petwords of speech _____________________________ (x) Physical Built __________________


    (x) Handwriting specimen ___________________________________________________________
    (xi)Signature of the employee/servant __________________________________________________
    14. Name & Local Address of Relatives & Friends in Delhi ________________________________
    .
    ________________________________________________________________________________
    .
    ________________________________________________________________________________
    15. INTRODUCED BY:Name, Address & Telphone No. ____________________________________________________
    .
    _________________________________________________________________________________
    16. DETAILS OF EMPLOYER
    Name, Address & Telephone No. ___________________________________________________
    .
    _________________________________________________________________________________

    Signature of the Employer

    FOR POLICE USE ONLY


    PART III
    1. Form Prepared by
    Name : ______________________________________ Rank ___________________________
    Range No. ____________________________________ PIS No. _________________________
    Police Station _________________________________ District __________________________
    2. Result of verification from CRO ___________________________________________________
    3. Result of verification from Finger Print Bureau _______________________________________
    .
    _________________________________________________________________________________
    4. Result of verification from previous employers ________________________________________
    _________________________________________________________________________________
    5. Result of verification from the concerned Police Station _________________________________
    (of Delhi to be done local PS)
    ________________________________________________________________________________
    ________________________________________________________________________________
    6. Details of verification form sent to DCP office for enquiry from SHO Home Town
    PS ____________________________ District ______________________ State
    ________________
    Despatch No. _____________________ Date ___________________
    S.H.O __________________________
    7. Result of verification from home town /Date & details of verification received from home town
    _________________________________________________________________________________
    S.H.O __________________________
    -----x-----x-----x-----x-----x-----x-----x-----x-----x-----x-----x-----x-----x-----x-----x-----x-----x-----x-----x-ACKNOWLEGEMENT
    Received Servant/Employee verification form from Sh./Smt. __________________________________
    in favour of Sh./Smt. __________________________________on ______________.

    Signature of Duty officer


    PS __________________

    PART II - A
    FINGER PRINT IMPRESSION OF EMPLOYEE/SERVANT
    (voluntarily given to the employer)
    (To be filled up by Employer only)
    1.

    Full name with aliases ___________________________________________________________

    2.

    Fathers or husbands Name _______________________________________________________

    3.

    Address _______________________________________________________________________
    ______________________________________________________________________________

    4.

    Police Station Sl. No. ____________________________________________________________

    FINGER PRINT IMPRESSION OF SERVANT/EMPLOYEE


    Right Thumb

    Left Little

    Right Index

    RIGHT HAND
    Right Middle

    Right Ring

    Right Little

    Left Ring

    LEFT HAND
    Left Middle

    Left Index

    Left Thumb

    Signature of employee
    Signature of employer

    PART II B
    RIGHT HAND IMPRESSION OF THE SERVANT/EMPLOYEE
    Plain prints of four fingers & thumbs taken simultaneously

    (Voluntarily given to the employer)


    (To be filled up by Employer only)
    Signature of employee
    Signature of employer

    PART II C
    LEFT HAND IMPRESSION OF THE SERVANT/EMPLOYEE
    Plain prints of four fingers & thumbs taken simultaneously

    (Voluntarily given to the employer)


    (To be filled up by Employer only)
    Signature of employee
    Signature of employer

    SERVANT VERIFICATION REGISTER


    1.
    2.

    Sl. No.
    Name & Address of
    employee

    3.

    Name, address &


    telephone no. of employer

    Description of employee
    4.
    Height
    5.
    Eyes
    6.
    Hairs
    7.
    Complexion
    8.
    Physical Built
    9.
    Identification mark
    10. Introduced by whom
    (Name, address &
    telephone numbers)
    11.

    Details of Relatives &


    Friends in Delhi if any

    12.

    Details of identity proof


    himself or family members

    13.

    Name and address of


    previous employer, if any

    14.

    Name of State/District
    where from sent for
    verification
    Verification result of local
    enquiry by Police Station
    staff
    Despatch detail/Date of
    sending for out station
    verification
    Date of reply received
    Address verified or not
    Verification detail

    15.

    16.
    17.
    18.
    19.
    20.
    21.
    22.
    23.

    Details of criminal record,


    if any
    Photograph
    Finger Print taken or not
    Remarks, if any

    PHOTO

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