背景調查信息表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)請提供清楚、準確、完整的打印或手寫信息（中國籍員工請打印或填寫中文）Colleges/Universities, Companies and addresses must be provided in full. Acronyms are not acceptable.大學院校, 公司名稱及地址須完整填寫. 請避免使用縮寫字。Company reserves the right to follow up from the candidate/employee if additional information is needed. 本公司保留必要時向候選人/員工進一步獲取更多信息的權利。Name (in English)（英文姓名）Gender（性別）： o Male（男） o Female（女）Name (in local language)（中文姓名）Date Joining Company:(加入Company日期)WWID（工號）: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（國籍）Identity Card No（身份證號碼）If you are a PRC citizen, please provide the below details and attach a copy of your Identification Card 中國籍公民請完整填寫以下信息并提供身份證復印件。Hukou Address, Jurisdiction Police Station and Hukou Type詳細戶口所在地址，管轄派出所及戶口類型Hukou Address戶口地址：Jurisdiction Police Station管轄派出所 ：Hu Kou Type戶口類型：Collective Registered Hukou & Collective Name集體戶口 集體名稱： Individual Registered Hu Kou個人戶口 Entity that holds the official personal record file, Tel No., Address, File No., File Registration Type人事檔案所在單位包括名稱、地址 、電話，存檔號碼及存檔類型Entitys Name單位名稱：Tel 電話：Registered by individual, File Registration No. 以個人名義存檔，存檔號碼：Registered by Employer, Employers Name 以雇主名義存檔，雇主名稱：For Students and Graduates whose personal record file are kept at the university only(人事檔案仍在學校的畢業生及在校學生請填寫此欄)學校school or university：系別、專業(department and major)：年級、學號(grade and student number)：已獲或將獲學位(degree)：If you have a US Social Security Number, please provide the below information:如您有美國的社會安全號碼，請提供以下信息:* US SSN 美國的社會安全號碼* Most recent US address (for US citizens and legal residents only) 最近的地址(僅適用于美國公民及美國法定居民)If you have a Canadian Social Insurance Number, please provide the below information: 如您有加拿大的社會保險號碼，請提供以下信息:* Canadian SIN 加拿大的社會保險號碼* Canada Combined Release Form (for Canadian citizens only) 加拿大組合豁免表(僅適用于加拿大公民)If you are an Australian citizen, please provide the below information 澳大利亞籍員工請提供以下信息:* Australia Criminal Record Check Form 澳大利亞犯罪記錄檢查表* A valid passport copy or Australian drivers license copy 有效的護照的復印件 或者 有效的澳大利亞的駕駛證復印件 Educational Qualifications (Highest Completed Degree Level Education only)教育背景（最高學歷學位）Please attach copies of certificates. If only High School Graduate, pls specify請附最高學歷學位復印件. 如僅有高中學歷, 請詳細說明Pls fill out complete details and provide complete names and addresses請填寫所有完整信息并提供準確,完整的名稱及地址College / University (1)院校名稱Period: From To（就學時間）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? 是否畢業 Yes NoType of degree attained所獲學位Major專業*Note: Kindly indicate other qualifications, if relevant to the job offered and attach copy of certificates 注意：如你具備同此工作相關的其他資質，請表明并將證書復印件附后。Employment History工作經歷Details of Current or Last Employer 目前或者進入本公司公司前最后一個雇主的詳細信息Pls fill out complete details and provide complete names, addresses, and phone numbers.請填寫所有完整信息并提供準確,完整的名稱, 地址及電話號碼。Company Name（公司名稱）:Nature of Business（性質）:Position Held（職位）:Address (main office and branch where worked)（地址）:Employment Period（就職起始時間）:From（自） To（至）HR contact (Name & Position & Telephone):相關人事部聯系人(姓名, 職位和電話）：Reported to (Name & Position & Telephone):（直接主管姓名, 職位和電話）：Department / Unit Name:(部門名稱) :Reason(s) for Leaving(離職原因)Do you grant permission for checks to be undertaken with this employer now? YES / NO (Please tick one) 您是否允許本公司在您入職本公司之前向該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，您何時會允許此項核查？ （日期不得遲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) 以前雇主的詳細信息（包括過去十年的，從最新的信息寫起 如果您過去十年在同一家公司工作，請填寫過去三家的雇主）Pls fill out complete details and provide complete names, addresses and phone numbers.請填寫所有完整信息并提供準確,完整的名稱, 地址及電話號碼）Company Name（公司名稱）:Nature of Business（性質）:Position Held（職位）:Address (main office and branch where worked)（地址）:Employment Period（就職起始時間）:From（自） To（至）HR contact (Name & Position & Telephone):（相關人事部聯系人姓名, 職位和電話）：Reported to (Name & Position & Telephone):（直接主管姓名, 職位和電話）：Department / Unit Name:(部門名稱) :Reason(s) for Leaving(離職原因)Company Name（公司名稱）:Nature of Business（性質）:Position Held（職位）:Address (main office and branch where worked)（地址）:Employment Period（就職起始時間）:From（自） To（至）HR contact (Name & Position & Telephone):（相關人事部聯系人姓名, 職位和電話）：Reported to (Name & Position & Telephone):（直接主管姓名, 職位和電話）：Department / Unit Name:(部門名稱) :Reason(s) for Leaving(離職原因)Please use blank paper to provide details of additional employers, if necessary.如果你還有額外的信息需要補充，請另附紙張。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. 如果你曾經因違法犯罪被控告，請認真閱讀以下內容并且有義務準確了解。以下類型的違法犯罪認定可能會對公司對你是否適合某一具體工作崗位及工作環境判斷產生負面影響，并可能最終導致公司拒絕或終止雇傭。認定包括申訴，裁定或者發現有罪而不論判決是否由法院所作出。這些犯罪包括但不僅限于（a）暴力犯罪（包括傷害，性侵害及家庭暴力），（b ）騷擾，非法跟蹤，賣淫嫖娼，或者妨害治安的行為，（c）涉及不誠實的違法犯罪，包括但不限于盜竊或詐騙，以及（d）其他任何涉及毒品或涉毒器具的違法犯罪（包括持有，使用并且/或者運輸販賣）。如果你不確定公司是否會因某一特定裁決而拒絕雇用，你有義務向公司人事招聘部門尋求解釋。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.違法犯罪記錄并不自動的阻止你的應聘。如果你的檔案里有緩刑假釋委員會封存的紀錄，你可以在回答過去是否有違法犯罪裁定的問題時作否定回答，此外在回答過去是否有刑事訴訟的問題時也可以做否定回答。輕微的交通違法犯罪（包括酒后駕駛這類輕罪）不需要提出或說明。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).在過去七年中你是否因為上述所列的違法犯罪行為（不論輕罪或重罪）而受到裁定，監禁，作為罪犯被登記，或被處以緩刑或假釋？（請注意：雖然本公司不會基于應聘者未導致有罪裁決的被捕行為作出是否雇用決定，你也不需要提出及說明未決的控告，但是如果出現的裁定可能導致你喪失應聘資格的情況下，未決的控告也可能使你不能應聘）。If Yes, please provide details (city, state of curt, date, offense, etc)-如果是，請提供詳細信息（城市，國家，日期，何種違法等等）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?-盡你所知，你是否了解你和現在的雇主或者其他公司簽訂有類似競業限制協議而可能會影響你能否在本公司工作？If Yes, please describe the limitations.-如果是，請列出相關限制。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?-你曾經有過以下情形嗎？包括因為不正當行為或者因為其他可能導致喪失本公司雇用資格的原因而被因特爾辭退， 未通過背景資格調查，或者曾被取消進入本公司相關設施的權限。If Yes, explain fully-如果是，請全面解釋。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