背景调查信息表.doc

背景调查信息表Personal Details Form (For Background Investigation)Please Print or Fill In Clearly and Provide Complete and Accurate Information(Chinese citizen please print or fill in Chinese)请提供清楚、准确、完整的打印或手写信息（中国籍员工请打印或填写中文）Colleges/Universities, Companies and addresses must be provided in full. Acronyms are not acceptable.大学院校, 公司名称及地址须完整填写. 请避免使用缩写字。Company reserves the right to follow up from the candidate/employee if additional information is needed. 本公司保留必要时向候选人/员工进一步获取更多信息的权利。Name (in English)（英文姓名）Gender（性别）： o Male（男） o Female（女）Name (in local language)（中文姓名）Date Joining Company:(加入Company日期)WWID（工号）:Former Name(s) / Maiden Name (if applicable)（曾用名）Date of Name Change（更名日期）Date of Birth (dd/mm/yy)（出生日期）Nationality（国籍）Identity Card No（身份证号码）If you are a PRC citizen, please provide the below details and attach a copy of your Identification Card 中国籍公民请完整填写以下信息并提供身份证复印件。Hukou Address, Jurisdiction Police Station and Hukou Type详细户口所在地址，管辖派出所及户口类型Hukou Address户口地址：Jurisdiction Police Station管辖派出所 ：Hu Kou Type户口类型：Collective Registered Hukou & Collective Name集体户口 集体名称： Individual Registered Hu Kou个人户口 Entity that holds the official personal record file, Tel No., Address, File No., File Registration Type人事档案所在单位包括名称、地址 、电话，存档号码及存档类型Entitys Name单位名称：Tel 电话：Registered by individual, File Registration No. 以个人名义存档，存档号码：Registered by Employer, Employers Name 以雇主名义存档，雇主名称：For Students and Graduates whose personal record file are kept at the university only(人事档案仍在学校的毕业生及在校学生请填写此栏)学校school or university：系别、专业(department and major)：年级、学号(grade and student number)：已获或将获学位(degree)：If you have a US Social Security Number, please provide the below information:如您有美国的社会安全号码，请提供以下信息:* US SSN 美国的社会安全号码* Most recent US address (for US citizens and legal residents only) 最近的地址(仅适用于美国公民及美国法定居民)If you have a Canadian Social Insurance Number, please provide the below information: 如您有加拿大的社会保险号码，请提供以下信息:* Canadian SIN 加拿大的社会保险号码* Canada Combined Release Form (for Canadian citizens only) 加拿大组合豁免表(仅适用于加拿大公民)If you are an Australian citizen, please provide the below information 澳大利亚籍员工请提供以下信息:* Australia Criminal Record Check Form 澳大利亚犯罪记录检查表* A valid passport copy or Australian drivers license copy 有效的护照的复印件 或者 有效的澳大利亚的驾驶证复印件 Educational Qualifications (Highest Completed Degree Level Education only)教育背景（最高学历学位）Please attach copies of certificates. If only High School Graduate, pls specify请附最高学历学位复印件. 如仅有高中学历, 请详细说明Pls fill out complete details and provide complete names and addresses请填写所有完整信息并提供准确,完整的名称及地址College / University (1)院校名称Period: From To（就学时间）自 至o Full Time （全日制）o Part Time（非全日制）College / University Address 院校地址:Did you graduate? 是否毕业 Yes NoType of degree attained所获学位Major专业*Note: Kindly indicate other qualifications, if relevant to the job offered and attach copy of certificates 注意：如你具备同此工作相关的其他资质，请表明并将证书复印件附后。Employment History工作经历Details of Current or Last Employer 目前或者进入本公司公司前最后一个雇主的详细信息Pls fill out complete details and provide complete names, addresses, and phone numbers.请填写所有完整信息并提供准确,完整的名称, 地址及电话号码。Company Name（公司名称）:Nature of Business（性质）:Position Held（职位）:Address (main office and branch where worked)（地址）:Employment Period（就职起始时间）:From（自） To（至）HR contact (Name & Position & Telephone):相关人事部联系人(姓名, 职位和电话）：Reported to (Name & Position & Telephone):（直接主管姓名, 职位和电话）：Department / Unit Name:(部门名称) :Reason(s) for Leaving(离职原因)Do you grant permission for checks to be undertaken with this employer now? YES / NO (Please tick one) 您是否允许本公司在您入职本公司之前向该雇主核查您所提供的信息？ 是/否 If no, when can the checks be undertaken? (Date must be on or before the Start date at Company)如果否，您何时会允许此项核查？ （日期不得迟于在本公司工作的初始日期）Details of Previous Employers (in descending order covering last 10 years - or three past employers if you have had the same employer for the past 10 years) 以前雇主的详细信息（包括过去十年的，从最新的信息写起 如果您过去十年在同一家公司工作，请填写过去三家的雇主）Pls fill out complete details and provide complete names, addresses and phone numbers.请填写所有完整信息并提供准确,完整的名称, 地址及电话号码）Company Name（公司名称）:Nature of Business（性质）:Position Held（职位）:Address (main office and branch where worked)（地址）:Employment Period（就职起始时间）:From（自） To（至）HR contact (Name & Position & Telephone):（相关人事部联系人姓名, 职位和电话）：Reported to (Name & Position & Telephone):（直接主管姓名, 职位和电话）：Department / Unit Name:(部门名称) :Reason(s) for Leaving(离职原因)Company Name（公司名称）:Nature of Business（性质）:Position Held（职位）:Address (main office and branch where worked)（地址）:Employment Period（就职起始时间）:From（自） To（至）HR contact (Name & Position & Telephone):（相关人事部联系人姓名, 职位和电话）：Reported to (Name & Position & Telephone):（直接主管姓名, 职位和电话）：Department / Unit Name:(部门名称) :Reason(s) for Leaving(离职原因)Please use blank paper to provide details of additional employers, if necessary.如果你还有额外的信息需要补充，请另附纸张。Self DisclosureIF YOU HAVE EVER BEEN CHARGED WITH A CRIME READ CAREFULLY. IT IS YOUR RESPONSIBILITY TO BE ACCURATE. The following types of criminal convictions may reflect negatively on your fitness for a specific job for the Company or on your ability to work in the Company work environment and may result in ineligibility for and/or termination of employment. Conviction includes plea, verdict or finding of guilt regardless of whether a sentence was imposed by the court. Such crimes include, but are not limited to (a) crimes of violence (including assault, battery, sexual offenses and domestic violence), (b) crimes involving harassment, stalking, prostitution, or disorderly conduct, (c) crimes involving dishonesty, including but not limited to theft or fraud, and (d) any crimes involving illegal drugs or drug paraphernalia (including possession, use, and/or trafficking crimes). If you have any doubt whether the Company would consider a specific conviction to be disqualifying, it is your obligation to seek clarification from staffing. 如果你曾经因违法犯罪被控告，请认真阅读以下内容并且有义务准确了解。以下类型的违法犯罪认定可能会对公司对你是否适合某一具体工作岗位及工作环境判断产生负面影响，并可能最终导致公司拒绝或终止雇佣。认定包括申诉，裁定或者发现有罪而不论判决是否由法院所作出。这些犯罪包括但不仅限于（a）暴力犯罪（包括伤害，性侵害及家庭暴力），（b ）骚扰，非法跟踪，卖淫嫖娼，或者妨害治安的行为，（c）涉及不诚实的违法犯罪，包括但不限于盗窃或诈骗，以及（d）其他任何涉及毒品或涉毒器具的违法犯罪（包括持有，使用并且/或者运输贩卖）。如果你不确定公司是否会因某一特定裁决而拒绝雇用，你有义务向公司人事招聘部门寻求解释。The existence of a criminal record does not automatically bar you from employment. If you have a sealed record on file with commissioner of probation, you may answer no with respect to an inquiry herein relative to prior convictions. In addition you may answer no with respect to an inquiry relative to criminal prosecution. Minor traffic offenses (including misdemeanor driving under the influence of alcohol) need not be disclosed.违法犯罪记录并不自动的阻止你的应聘。如果你的档案里有缓刑假释委员会封存的纪录，你可以在回答过去是否有违法犯罪裁定的问题时作否定回答，此外在回答过去是否有刑事诉讼的问题时也可以做否定回答。轻微的交通违法犯罪（包括酒后驾驶这类轻罪）不需要提出或说明。During the last seven (7) years, have you been convicted, incarcerated, required to register as an offender, or on parole or probation for any misdemeanor or felony offense as described above? (Please note: While Company does not base its hiring decisions on arrest not resulting in convictions, and you are not required to disclose pending charges, pending charges that would be disqualifying if a conviction occurred may result in temporary ineligibility pending resolution).在过去七年中你是否因为上述所列的违法犯罪行为（不论轻罪或重罪）而受到裁定，监禁，作为罪犯被登记，或被处以缓刑或假释？（请注意：虽然本公司不会基于应聘者未导致有罪裁决的被捕行为作出是否雇用决定，你也不需要提出及说明未决的控告，但是如果出现的裁定可能导致你丧失应聘资格的情况下，未决的控告也可能使你不能应聘）。If Yes, please provide details (city, state of curt, date, offense, etc)-如果是，请提供详细信息（城市，国家，日期，何种违法等等）To the best of your knowledge and belief, are you aware of any contract or agreement with your current employer (or other company), such as a non-competition agreement, that might impact or interfere with your ability to work in any way for the Company?-尽你所知，你是否了解你和现在的雇主或者其他公司签订有类似竞业限制协议而可能会影响你能否在本公司工作？If Yes, please describe the limitations.-如果是，请列出相关限制。Have you ever been terminated by Company for misconduct or any other reason that may make you ineligible for employment with Company, failed a background investigation, or been denied access to Company facilities?-你曾经有过以下情形吗？包括因为不正当行为或者因为其他可能导致丧失本公司雇用资格的原因而被因特尔辞退， 未通过背景资格调查，或者曾被取消进入本公司相关设施的权限。If Yes, explain fully-如果是，请全面解释。Name- Date （姓名） （日期）DeclarationI hereby certify all of the statements made on the Company personal details form are true, complete, and consistent to the resume/application submitted to Company. I understand that omission or misrepresentation of any fact in this form may result in disciplinary action up to including refusal of employment or termination of my employment, consistent with Company HR Guidelines for Discipline and Discharge.I recognize that in connection with employment with Company, I may be the subject of a background enquiry by Company or their agents, First Advantage Quest Research Ltd, and I hereby au