APPLICATION FOR POLICE VERIFICATION
To,
The Station House Officer,
Police Station Police Station Sector 26, Chandigarh.
Date: 2 April 2026
Place: Chandigarh
Subject: Application for antecedent and character verification of Suresh Kumar, engaged/proposed to be engaged as domestic help, maid or housekeeping staff
Sir/Madam,
- 1. I, Karamjeet Singh Bajwa, an individual householder engaging the employee for domestic service at my residence, acting through Ritu Mahajan, Secretary, authorised by the Managing Committee resolution dated 2 March 2026, of House No. 812, Sector 21-B, Chandigarh 160022, phone 98140 12345, have engaged, or propose to engage, the person named below, and request that their antecedents and character be verified before or during that engagement.
- 2. PARTICULARS OF THE EMPLOYEE
Name: Suresh Kumar
Nature of engagement: domestic help, maid or housekeeping staff
Father's/husband's name: Ram Lal
Date of birth/age: 14 June 1992
Permanent address: Vill. Bhadson, P.O. Bhadson, Tehsil Patiala, District Patiala, Punjab 147021
Present address: Room No. 4, Ward No. 9, Colony Number 5, Chandigarh 160002
Identity proof produced: Aadhaar card, number X
Contact number: 98765 43210
Date from which engaged/proposed to be engaged: 1 April 2026
- 3. PREVIOUS EMPLOYMENT, REFERENCE AND AGENCY, IF ANY
Previous employer: Mr and Mrs Arora, House No. 1145, Sector 15, Panchkula, employed Suresh Kumar as a driver from June 2022 to February 2026, phone 98723 45678
Local reference: Balwinder Singh, House No. 220, Sector 21-B, Chandigarh, phone 94170 22334
Placement/security agency: Secure Force Security Services Pvt. Ltd., SCO 84, Sector 34-A, Chandigarh, PSARA Licence No. CH/PSARA/2019/0231
- 4. 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.
- 5. CONSENT AND DECLARATION BY THE EMPLOYEE
I, Suresh Kumar, 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: Suresh Kumar
Date: 2 April 2026
- 6. 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: ______________________
Karamjeet Singh Bajwa
Through: Ritu Mahajan, Secretary, authorised by the Managing Committee resolution dated 2 March 2026
Address: House No. 812, Sector 21-B, Chandigarh 160022
Phone: 98140 12345