EMPLOYMENT DETAIL FORM

Instructions
1.Use BLOCK (CAPITAL ) letters only
2. All Fields are mandatory

JOINING LOCATION: ___________________________

Good to have
DOJ:__________ Salary Code #____________

Grade:________ Job Title/Designaiton:_____________________

PART 1

1)NAME: (First, middle, Last):

2a) Father's Name : DOB
2b) Mother's Name : DOB
2c) Spouse's Name : DOB

3)GENDER: Married
4) 6)DATE OF
Male 5)Marital Status : Divorcee
Nationality: BIRTH:
Female Unmarried
Number: Date of Issue:
7)PASSPORT:
Place of Issue: Valid upto:
Number: Date of Issue:
8)DRIVING LICENCE:
Place of Issue: Valid upto:
9a) PAN CARD: Number: 9b) AADHAR CARD Number:
10) PRESENT ADDRESS : 11) PERMANENT ADDRESS:

Landmark : Landmark :
Tel. # Tel. #
Present address: Address where you are currently residing.
Permanent address: Address where you are permanently residing, irrespective of present address. This is typically your parents residence or home town
12) Personal Email -ID :
(For Mediclaim Insurance)

AGE Gender
13a) Family Details: Name DOB DD/MM/YY
Spouse
 Child 1
Child 2
Child 3
13b) Blood Group 13c) Physically disabled If Yes, pls attach relevant Doc
Yes / No
Signature of the Applicant :__________________________________________
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AtoS India
14)PERSON TO BE CONTACTED IN CASE OF EMERGENCY:
Name Address & Phone No E-mail ID

15) (FOR INSURANCE - NOMINEE DETAIL)

Nominee
Relationship with Nominee DOB
Nominee Name Nominee Address Nominee Gender DD/MM/YY

16)REFERENCES :
Please mention the name of two persons you know.
Name Designation How do you know him/her Phone No

17)LANGUAGES KNOWN(Please Tick Mark)

Language Read Speak Write Highest Degree

Total Experience

18) Bank Account Details :

Name of the Bank ( Any one) Pls Tick Name of other Bank :
ICICI Name of Branch:
HDFC A/c. No.
Standard Chartered IFSC Code:
Other Bank PAN CARD No
Please Attach Cancelled Cheque Leaf

Signature of the Applicant:_______________________________________

 Page 2of 7
AtoS India
PART 2(This information will be used for Background Verification)
Employee ID/ Applicant ID: Location: DOJ:

NAME: (First, middle, Last):

FATHER's/ SPOUSE's Name : Relation :
Date of Birth:
Mobile No: Landline No:
EDUCATION(Highest Degree first)

Degree From To
Specialization
College Name & Address (If Any ) ( Name of Board/University Month & Month &
course) Year Year
Post- Graduation -1

Post- Graduation

Graduation

Diploma

12th or Equivalent

10th or Equivalent

Any Significant Contribution in your Career:

Other Skills:
Signature of the Applicant:_______________________________________
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AtoS India
EMPLOYMENT HISTORY(List Details of previous employers: Pls fill complete details)- Recent employer first
1)LAST EMPLOYER
1) Name of the Last Employer: Address of the Last Employer:

Telephone No: Designation: (Available on payslip) Employee/Salary Code Department:

Employment Period Manager's name & contact details HR Contact No :

Start Date in HR office E-mail ID:
DD/MM/YY
End Date in
DD/MM/YY
Reason For leaving: Was this position Agency Details(incase of
contractual employment)
Permanent
First Salary Drawn (Annual CTC) Temporary
Last Salary Drawn (Annual CTC) Contractual
2)PREVIOUS EMPLOYER
2)Name of the Previous Employer: Address of the Previous Employer:

Telephone No: Designation: (Available on payslip) Employee / Salary Code Department:

Employment Period Manager's name & contact details HR Contact No :

Start Date in HR office E-mail ID:
DD/MM/YY
End Date in
DD/MM/YY
Reason For leaving: Was this position Agency Details(incase of
contractual employment)
Permanent
First Salary Drawn (Annual CTC) Temporary
Last Salary Drawn (Annual CTC) Contractual

3)PREVIOUS EMPLOYER
3)Name of the Previous Employer: Address of the Previous Employer:

Telephone No: Designation: (Available on your payslip) Employee / Salary Code Department:

Employment Period Manager's name & contact details HR Contact No :

Start Date in HR office E-mail ID:
DD/MM/YY
End Date in
DD/MM/YY
Reason For leaving: Was this position Agency Details(incase of
contractual employment)
Reason For leaving: Agency Details(incase of
contractual employment)
Permanent
First Salary Drawn (Annual CTC) Temporary
Last Salary Drawn (Annual CTC) Contractual

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AtoS India
4)PREVIOUS EMPLOYER
4)Name of the Previous Employer: Address of the Previous Employer:

Telephone No: Designation: (Available on payslip) Employee / Salary Code Department:

Employment Period Manager's name & contact details HR Contact No :

Start Date in HR office E-mail ID:
DD/MM/YY
End Date in
DD/MM/YY
Reason For leaving: Was this position Agency Details(incase of
contractual employment)
Permanent
First Salary Drawn (Annual CTC) Temporary
Last Salary Drawn (Annual CTC) Contractual

5)PREVIOUS EMPLOYER
5)Name of the Previous Employer: Address of the Previous Employer:

Telephone No: Designation: (Available on payslip) Employee / Salary Code Department:

Employment Period Manager's name & contact details HR Contact No :

Start Date in HR office E-mail ID:
DD/MM/YY
End Date in
DD/MM/YY
Reason For leaving: Was this position Agency Details(incase of
contractual employment)
Permanent
First Salary Drawn (Annual CTC) Temporary
Last Salary Drawn (Annual CTC) Contractual

6)PREVIOUS EMPLOYER
6)Name of the Previous Employer: Address of the Previous Employer:

Telephone No: Designation: (Available on payslip) Employee / Salary Code Department:

Employment Period Manager's name & contact details HR Contact No :

Start Date in HR office E-mail ID:
DD/MM/YY
 HR office E-mail ID:

End Date in
DD/MM/YY
Reason For leaving: Was this position Agency Details(incase of
contractual employment)
Permanent
First Salary Drawn (Annual CTC) Temporary
Last Salary Drawn (Annual CTC) Contractual

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AtoS India
7) PREVIOUS EMPLOYER
7)Name of the Previous Employer: Address of the Previous Employer:

Telephone No: Designation: (Available on payslip) Employee / Salary Code Department:

Employment Period Manager's name & contact details HR Contact No :

Start Date in HR office E-mail ID:
DD/MM/YY
End Date in
DD/MM/YY
Reason For leaving: Was this position Agency Details (incase of
contractual employment)
Permanent
First Salary Drawn (Annual CTC) Temporary
Last Salary Drawn (Annual CTC) Contractual

8)PREVIOUS EMPLOYER
8)Name of the Previous Employer: Address of the Previous Employer:

Telephone No: Designation: (Available on payslip) Employee / Salary Code Department:

Employment Period Manager's name & contact details HR Contact No :

Start Date in HR office E-mail ID:
DD/MM/YY
End Date in
DD/MM/YY
Reason For leaving: Was this position Agency Details (incase of
contractual employment)
Permanent
First Salary Drawn (Annual CTC) Temporary
Last Salary Drawn (Annual CTC) Contractual

9)PREVIOUS EMPLOYER
9)Name of the Previous Employer: Address of the Previous Employer:

Telephone No: Designation: (Available on payslip) Employee / Salary Code Department:

Employment Period Manager's name & contact details HR Contact No :

Start Date in HR office E-mail ID:
DD/MM/YY
End Date in
DD/MM/YY
Reason For leaving: Was this position Agency Details (incase of
contractual employment)
Reason For leaving: Agency Details (incase of
contractual employment)
Permanent
First Salary Drawn (Annual CTC) Temporary
Last Salary Drawn (Annual CTC) Contractual
Page 6 of 7
AtoS India
10)PREVIOUS EMPLOYER
10)Name of the Previous Employer: Address of the Previous Employer:

Telephone No: Designation: (Available on payslip) Employee / Salary Code Department:

Employment Period Manager's name & contact details HR Contact No :

Start Date in HR office E-mail ID:
DD/MM/YY
End Date in
DD/MM/YY
Reason For leaving: Was this position Agency Details (incase of
contractual employment)
Permanent
First Salary Drawn (Annual CTC) Temporary
Last Salary Drawn (Annual CTC) Contractual

Declaration
Sr. no Declaration Questions Yes /no Provide Explanation in case Yes is marke

1
Have you ever been refused entry to any foreign country?

2 Have you ever been subject to any pending investigation/

proceedings/Police case investigation which may lead to
conviction or currently charged and/or convicted of any offence,
served any term of sentence, under any law in any jurisdiction?

3 Have you ever been the subject of any investigation or disciplinary

proceeding or been issued a warning or reprimand or been
notified of any potential proceedings or of any investigation which
might lead to such proceedings, by any regulatory authority,
Judiciary, any professional body or government agency, in any
jurisdiction?

4 Have you ever contravened or abetted another person in breach

of any laws or regulations, business rules or codes of conduct, in
any jurisdiction or entity ?

5 Have you ever been or are you currently subject to a judgment

debt which is unsatisfied, either in whole or in part, in any
jurisdiction?

6 Have you ever been dismissed or asked to resign from any office,
employment, a position of trust, or a fiduciary appointment or
similar position, in any jurisdiction?

7
Have you ever been subject to disciplinary proceedings by your
former employer(s), in any jurisdiction?
8 Have you ever been disqualified from acting as a director or
disqualified from acting in any managerial capacity, in any
jurisdiction?

9 Do you hold any position as a Director/MD/President or any

position in any Company or sole proprietor/partnership or
organisation or Politically connected organisation or disqualified
from acting in any managerial capacity, in any jurisdiction?

Is there / will there be any potential areas of conflicts of interest

10 arising from your proposed duties as a representative/employee
of Atos or any of its affiliates and your directorship(s) and/or
relationship.

Declaration and Authorization:

I hereby authorize AtoS India Pvt Ltd "Company" and any of its affiliates (or third party agent appointed by the company) to ver
information presented in above form and provided by myself; and further to contact any former employers/educational
institutes/related parties (including Government authorities and agencies, etc.) and carry out all background checks and to pro
investigation report or any other required report or information for that purpose not restricted to education and employment
deemed appropriate.
I hereby authorise and give consent to persons and entities (including former employers, education institutions, Government
authority, agencies, other entities, etc.) to release any information as related with above and I hereby release them from any
liability whatsoever in doing so.
I confirm that the above information is true, correct, complete and best of my knowledge and I make them freely without any
reservations. I understand that my employment with the organisation may be terminated with immediate effect and/or is subj
to action based on Company's discretion should any information provided herein be determined by the Company to be untrue
deliberately misleading.
I read, understand and by my signature I consent to all statements.

Name: _________________________________________ Date: ________________________

Signature: ______________________________________ Place: _______________________

Verified by : ____________________________________
( Name and Signature )
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AtoS India
 Good to have

Date of Issue:
Valid upto:
Date of Issue:
Valid upto:

11) PERMANENT ADDRESS:

Landmark :
Tel. #

, irrespective of present address. This is typically your parents residence or home town

Date of
Marriage
If Yes, pls attach relevant Document

ABS V 1.0- 2016

CY:
E-mail ID

Proportion to
be shared (%)

Phone No

Attach Cancelled Cheque Leaf

ABS V 1.0- 2016
d Verification)
DOJ:

Relation :

Landline No:

Roll No/ID
ABS V 1.0- 2016
yers: Pls fill complete details)- Recent employer first

Address of the Last Employer:

Department:

HR Contact No :
HR office E-mail ID:

Agency Details(incase of
contractual employment)

Address of the Previous Employer:

Department:

HR Contact No :
HR office E-mail ID:

Agency Details(incase of
contractual employment)

Address of the Previous Employer:

Department:

HR Contact No :
HR office E-mail ID:

Agency Details(incase of
contractual employment)
Agency Details(incase of
contractual employment)

ABS V 1.0- 2016

Address of the Previous Employer:

Department:

HR Contact No :
HR office E-mail ID:

Agency Details(incase of
contractual employment)

Address of the Previous Employer:

Department:

HR Contact No :
HR office E-mail ID:

Agency Details(incase of
contractual employment)

Address of the Previous Employer:

Department:

HR Contact No :
HR office E-mail ID:
HR office E-mail ID:

Agency Details(incase of
contractual employment)

ABS V 1.0- 2016

Address of the Previous Employer:

Department:

HR Contact No :
HR office E-mail ID:

Agency Details (incase of

contractual employment)

Address of the Previous Employer:

Department:

HR Contact No :
HR office E-mail ID:

Agency Details (incase of

contractual employment)

Address of the Previous Employer:

Department:

HR Contact No :
HR office E-mail ID:

Agency Details (incase of

contractual employment)
Agency Details (incase of
contractual employment)

ABS V 1.0- 2016

Address of the Previous Employer:

Department:

HR Contact No :
HR office E-mail ID:

Agency Details (incase of

contractual employment)

Provide Explanation in case Yes is marked

ny of its affiliates (or third party agent appointed by the company) to verify
myself; and further to contact any former employers/educational
rities and agencies, etc.) and carry out all background checks and to procure
ormation for that purpose not restricted to education and employment

tities (including former employers, education institutions, Government

nformation as related with above and I hereby release them from any

omplete and best of my knowledge and I make them freely without any
he organisation may be terminated with immediate effect and/or is subject
formation provided herein be determined by the Company to be untrue or

statements.

Date: ________________________

Place: _______________________

ABS V 1.0- 2016