APPLICATION FOR POLICE VERIFICATION
To,
The Station House Officer,
Police Station __________.
Date: __________
Place: __________
Subject: Application for antecedent and character verification of __________, engaged/proposed to be engaged as __________
Sir/Madam,
- I, __________, __________, of __________, phone __________, have engaged, or propose to engage, the person named below, and request that their antecedents and character be verified before or during that engagement.
- PARTICULARS OF THE EMPLOYEE
Name: __________
Nature of engagement:
Father's/husband's name: __________
Date of birth/age: __________
Permanent address: __________
Present address: __________
Identity proof produced: __________, number __________
Contact number: __________
Date from which engaged/proposed to be engaged: __________
- PREVIOUS EMPLOYMENT, REFERENCE AND AGENCY, IF ANY
- UNDERTAKING BY THE EMPLOYER
I undertake to inform this police station in writing if the engagement ends, if the employee's address changes to my knowledge, or if anything bearing on the employee's character comes to my notice during the engagement. I understand that engaging this person before verification is complete is at my own risk, and that this application does not itself certify the employee's character until the police station's report is received.
- CONSENT AND DECLARATION BY THE EMPLOYEE
I, __________, confirm that the particulars given about me above are true to the best of my knowledge, and I consent to the police verifying my antecedents at the addresses given above and with the previous employer and reference named, for the purpose of this engagement. I understand that furnishing false particulars is an offence.
Signature of the employee: ______________________
Name: __________
Date: __________
- DOCUMENTS ATTACHED
Self-attested photocopy of the identity proof named in item 2; two recent passport-size photographs of the employee.
Signature of the applicant/employer: ______________________
__________
Address: __________
Phone: __________
FOR POLICE USE ONLY — NOT TO BE FILLED BY THE APPLICANT
Application/portal reference number: ____________________
Report called for from Police Station: ____________________ on: ____________________
Verification report received on: ____________________
Remarks: ____________________________________________________________
Verifying Officer's name, rank and signature: ____________________________________________________________