This document is a police verification form used to verify the antecedents of an employee. It requests personal details such as name, addresses, dates of birth, education history, employment history, references, and a declaration that the candidate is fit for government employment and unaware of any issues that could impair their fitness. The candidate must sign to certify the information is correct, and a gazetted officer or other authority must also sign to verify they have known the candidate and believe the details provided are accurate.

1. POLICE VERIFICATION<br />FORM FOR VERIFICATION OF ANTECEDENTS OF THE EMPLOYEE<br />Name in full (in block letters with address if any) Please indicate if you have added or dropped at any stage any part of your name or surnamePresent address in full i.e. Vill. Thana & Distt. House No. Lane Street & RoadHouse address in full i.e. Vill. Thana & Distt. House No. Lane Street & RoadIf originally a resident of Pakistan, the address in that dominion and the date of migration to the Indian UnionParticulars of the place where you have resided for more than one year during the preceding five years. FromToResidential address in fulli.e. Vill. Thana & Distt. House No. Lane Street & RoadFather’s name in full with address if anyPresent postal address, if dead give last addressPermanent home addressProfessionIf in service, give designation and official addressNationalityFatherMother HusbandWifePlace of birthHusbandWifeExact date of birthPresent ageAge at matriculationPlace of birth district & state in which it is situatedDistt. & state to which you belongState your religionAre you a member of scheduled caste / scheduled tribe, if so state the home thereof<br />Educational qualification showing place of education year in school and college since 15 year of ageName of school/collegeDate of entryDate of leavingExamination passedIf you have any time been employed give detailsDesignation of post held and description of workFromToFull address of the office, firm or institutionHave you ever been convicted by a court or any office. if the answer is yes, give the full particulars of conviction and the sentence Names of two responsible persons of your locality or two references to whom you are knownI certify that the foregoing information is correct and complete to the best of my knowledge and belief. I am not aware of any circumstances which might impair my fitness for employment under the govt.DateSignature of candidate _________________PlaceCertificate to be signed by a gazetted officer or member of legislature or authority prescribed by the appointing authorityCertified that I have known Sh./Smt. ____________________________________________ son/daughter of ____________________________ for the last ______________ years and that to the best of my knowledge and belief the particulars furnished by him/her are correct. DateSignature ___________________________PlaceDesignation or status and address<br />