To, The Station House Officer, Police Station __________.
Sir/Madam,
1. 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.
2. PARTICULARS OF THE EMPLOYEE
3. PREVIOUS EMPLOYMENT, REFERENCE AND AGENCY, IF ANY
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
6. DOCUMENTS ATTACHED
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: ____________________________________________________________