Background Check Form

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Authorization and Release Letter of Personal Information for Background Check

I understand that eeCheck Pte. Ltd. and its agents (hereafter refer as “EECHECK”) has been engaged to make all necessary arrangement to obtain the following information (hereafter refer as “BACKGROUND CHECK INFORMATION”) related to my background:

▪ Employment, work history and job performance

▪ Education, professional qualifications, certifications, and credentials

▪ Credit history check

▪ Bankruptcy / insolvency record check

▪ Conflict of interests / directorship record check

▪ Civil litigation record check

▪ Financial regulatory record check

▪ Court records, media records, watchlists and any adverse information in different public sources

I hereby authorize and give consent to EECHECK to make all necessary arrangement including but not limited to utilizing information provided on this document, CV, application form and other documents provided to EECHECK and my prospective employer/employer (hereafter refer as “FIRM”) to obtain the BACKGROUND CHECK INFORMATION and release to FIRM only. I understand that EECHECK will release such information to any other third party only if required to obtain the BACKGROUND CHECK INFORMATION. I certify that all information I have provided in this document, CV, application form, and other documents provided is true, complete and correct. I understand that failure to provide accurate and complete information may disqualify me from further consideration for employment and could result in my subsequent termination and dismissal for cause if I do gain a position with FIRM. I authorize all persons who may have information relevant to this enquiry to disclose the information to EECHECK and FIRM. I release all persons from liability on account of such disclosure. I further release EECHECK and FIRM from any liability or cause of legal action arising from the background check process and the release of any information collected by EECHECK during this process. I am willing that a photocopy of this authorization be accepted with the same authority as the original.

Signature(Required)

Date of Signature(Required)

Full Name in English (as appears in Passport)(Required)

First Middle Last Maiden Name

Former Name in English (if applicable)

First Middle Last Maiden Name

Full Name in Local Characters

(if applicable)

Local ID Number (e.g., NRIC, PRC ID, HKID)(Required)

LAST 4 DIGITS ONLY

Birth Date(Required)

Gender(Required)

Male

Female

The information contained in this document is strictly confidential and intended solely for the use of the designated addressee(s). Any unauthorised viewing, disclosure, copying or distribution of this document or attachments is prohibited. If you have received this document in error, please do not read it, reply to the sender immediately to inform us that you are not the intended recipient, and destroy any copies. Thank you.

CONTACT DETAILS AND ADDITIONAL IDENTIFICATION INFORMATION

Contact Number(Required)

Email Address(Required)

Full Local ID Number (e.g., NRIC, PRC ID, HKID)(Required)

Please DO NOT provide Local ID for Japan or South Korea

Country/ Region issued(Required)

(The country or region that officially issued the Local ID)

Full Passport Number(Required)

Nationality(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

The information contained in this document is strictly confidential and intended solely for the use of the designated addressee(s). Any unauthorised viewing, disclosure, copying or distribution of this document or attachments is prohibited. If you have received this document in error, please do not read it, reply to the sender immediately to inform us that you are not the intended recipient, and destroy any copies. Thank you.

EMPLOYMENT REFERENCE INFORMATION (PAGE 1)

Instructions (Important to Read Carefully):

▪ Simply put “N/A” for items that are not relevant or not available.
▪ Please include your LATEST 2 EMPLOYMENT DETAILS (INCLUDING PART-TIME OR INTERNSHIP EXPERIENCES).
▪ DO NOT list any CURRENT employers that you do not wish EECHECK to contact on Employment Reference Information PAGE 1.
▪ List your CURRENT employer on Employment Reference Information PAGE 2 when the employer/contacts are to be contacted at the later stage.
▪ DO NOT include any organization related to your current employer (within the same group) on Employment Reference Information PAGE 1 if you do not wish EECHECK to contact them at this stage. Please combine all current employer-related organizations as one single entity and include this consolidated information on Employment Reference Information PAGE 2.
▪ Please note that EECHECK may contact anyone from Human Resources Department/Record in charge of the respective company for employment verification in this consent form.
▪ For referee’s information, please provide your Direct Manager or Supervisor. Family, co-workers or friends are not applicable.

Please provide your Latest 2 FORMER EMPLOYER(S) Information:

Do you approve EECHECK contacting your Current Employer for reference purposes?(Required)

If NO, please fill in your Current Employer Information in the next page ONLY

Not Currently Employed

Yes (If YES, please fill in your Current Employer Information in the below table)

Current Employer Information

***DO NOT fill in the next page if you have completed this table)***

Current Company Name

If not employed directly by the Company, please provide the Secondment / Agency Name (If Applicable)

Location (Address, City, and Country)

Location of Secondment / Agency Name (Address, City, and Country) (If Applicable)

Last Position Held

(Final position or job title you held)

Employment Status

(Full-Time/ Part-Time/Internship)

Starting Date (mm/yyyy)

Ending Date (mm/yyyy)

HR Name

HR Contact Number

HR Email Address

Supervisor/ Referee Name & Job Title

Supervisor/ Referee Contact Number

Supervisor/ Referee Email Address

Reason for Leaving

Former Employer Information #1

Company Name(Required)

If not employed directly by the Company, please provide the Secondment / Agency Name (If Applicable)

Location (Address, City, and Country)(Required)

Location of Secondment / Agency Name (Address, City, and Country) (If Applicable)

Last Position Held(Required)

(Final position or job title you held)

Employment Status(Required)

(Full-Time/ Part-Time/Internship)

Starting Date (mm/yyyy)(Required)

Ending Date (mm/yyyy)(Required)

HR Name

HR Contact Number

HR Email Address

Supervisor/ Referee Name & Job Title

Supervisor/ Referee Contact Number

Supervisor/ Referee Email Address

Reason for Leaving(Required)

Former Employer Information #2

Company Name(Required)

If not employed directly by the Company, please provide the Secondment / Agency Name (If Applicable)

Location (Address, City, and Country)(Required)

Location of Secondment / Agency Name (Address, City, and Country) (If Applicable)

Last Position Held(Required)

(Final position or job title you held)

Employment Status(Required)

(Full-Time/ Part-Time/Internship)

Starting Date (mm/yyyy)(Required)

Ending Date (mm/yyyy)(Required)

HR Name

HR Contact Number

HR Email Address

Supervisor/ Referee Name & Job Title

Supervisor/ Referee Contact Number

Supervisor/ Referee Email Address

Reason for Leaving(Required)

EDUCATION AND/OR CERTIFICATION AND CREDENTIAL INFOMATION

*Note: Please fill in your Highest Education Qualifications for Bachelor or Above Qualifications – including Awarded and Non-Awarded. You may simply leave the field blank or put “N/A” for items that are not relevant or information that is not available.

Qualification Details #1 (Include Awarded or Non-Awarded)

Full Name of Awarding Institution(Required)

Country of Awarding Institution(Required)

Full Address of Institution(Required)

Student Full Name(Required)

(Exact Student Name Registered with the Institution)

Official Name of the Qualification Awarded(Required)

(As Stated on Certificate)

Qualification Level(Required)

(e.g., Bachelor’s Degree, Master’s Degree, Doctoral Degree)

Mode of Study(Required)

(Full-Time/ Part-Time/ Distance Learning)

Faculty(Required)

(e.g., Faculty of Medicine, Business, etc.)

Student Number

(e.g., Student ID or Student ID Number)

Period of Study (mm/yyyy)(Required)

(Start Date and End Date)

Academic Qualification Status(Required)

(Awarded / Not Awarded)

Graduation Date(Required)

(mm/yyyy)

Award Date (mm/yyyy)(Required)

Copy of Resume(Required)

Drop files here or

Max. file size: 150 MB.

Copy of Graduation Certificate(Required)

Drop files here or

Max. file size: 150 MB.

Local ID Copy & Passport Copy(Required)

Drop files here or

Max. file size: 150 MB.

Reference Letter(s)(Required)

Drop files here or

Max. file size: 150 MB.

Background Check Form