Extra Jurisdiction - Essential Information Checklist OCT2013

Please complete and return

J.P. Morgan – Pre Employment Screening Extra Jurisdiction - Essential Information Checklist

1. Have you ever resided, worked or studied in the following locations within the last five (5)

years?

2. Is your nationality one of the below locations?

3. Do you hold citizenship for one or more of the below locations?

If YES, provide the requested information

Australia YES

1. Complete ‘Australian Federal Police (AFP) Check’ form

� All fields in the AFP form are to be completed

� “Position/Role” refers to the position in JPMC

� Dates should be in dd/mm/yy format

� All addresses provided should be indicated with a date period

e.g. George Street, Sydney (Jan 2000 – Jan 2005)

� Name and Signature on the form should be identical to that on the ID provided.

� Photo and signature pages of Passport or Driving License copy

NO

No information required

* Important Note: AFP may require up to 3 to 4 weeks for further investigation of cases with possible criminal name matches. Asia PES shall inform the requestor of such developments and the intended onboarding shall be re-scheduled.

Argentina

YES

1. To provide complete Argentina Residential Address, Full Name, Date of Birth, Argentina

Computerised National Identity Card Number (CNIC).

2. To provide Mother’s Maiden Name

NO


Austria YES 1. To provide complete Austria Residential Address, Full Name, Date of Birth, Austria National

Identity Number.

NO


Bangladesh

YES 1. To provide complete Bangladesh Residential Address with period of stay, Full Name, Date of

Birth. 2. To provide Father’s Full Name.

NO


Belgium YES

1. To provide complete Belgium Residential Address with period of stay, Full Name, Date of Birth.

NO



Bermuda YES

1. To provide complete Bermuda Residential Address, Full Name, Date of Birth.

2. To provide Mother’s Maiden Name, Father’ Full Name.

NO


Canada YES

1. Complete and return the ‘Canada Criminal Check’ form

2. Canada Social Insurance Number (SIN) – if any.

3. Canada Residential Address with Postal Code.

4. Copies of 2 government issued Identity documents. Complete list:

• Passport (Canadian or foreign)

• Drivers licence (Canadian or foreign)

• Permanent Resident card

• Canadian Citizenship card

• Certificate of Indian Status

• International Student Identity Card

• Firearms Acquisition Certificate

• Canadian National Institute of the Blind (CNIB) Identification Card

• Federal/Provincial/Municipal Identification Card – Some provinces issue a photo ID card through the Ministry of Transportation (Driver’s Licence Offices) for those persons who do not have a driver’s licence and have a need for an ID card. Other provincial ministries also issue ID cards to show proof of age required to purchase liquor. This form of ID is also known as an “Age of Majority” card.

The following may be used as secondary forms of ID if a second form of government issued photo ID is not available.

• Hunting Licence

• Fishing Licence

• Boating Licence

• LCBO (BYID) card

• Student card

• Birth certificate

NO


Canada Social Insurance Number (CSIN)

China YES

1. Complete and return the ‘China Criminal Check - PRC 101 Record Check’ form. All details must

be in English & Chinese.

2. For Chinese Citizen, to provide full name in Chinese Character, PRC National Identity Number,

PRC Hukou address are mandatory requirements.

3. For foreigners, to provide a copy of passport.

NO


Denmark YES

1. To provide complete Denmark Residential Address, Full Name, Date of Birth, Denmark National

Identity Number.

NO



Germany

YES 1. To provide complete Germany Residential Address, Full Name, Date of Birth.

NO


Honduras YES

1. To provide complete Honduras Residential Address with period os stay, Full Name, Date of Birth.

2. To provide Mother’s Maiden Name, Father’ Full Name.

NO


Hong Kong YES

1. Provide your Hong Kong Identification number in the space provided

(right)

2. Complete Hong Kong Residential Address, Full Name, Date of Birth.

3. If Tertiary education is obtained at:

� Open University please complete the ‘Open University Letter of

Authorisation’ form AND / OR

� Chinese University please complete the ‘University Letter of

Authorisation’ form

NO


HKID Number:

India YES

1. Candidates Full Name

2. Date of Birth

3. Father’s complete name

4. Full address/s in India and period of stay

NO


Indonesia YES

1. For Indonesia Citizen, to provide Full Name, National Identity

Number (KTP), Passport Number, Date of Birth, Complete Indonesia

Residential Address.

2. For foreigners, to provide a copy of passport, Complete Indonesia


NO


Indonesian Identity Nunber

(KTP):

Ireland YES

1. Complete Ireland Residential Address.

2. Candidate's full name (including any aliases/maiden names) and Date of Birth.

3. Previous Addresses in Ireland (if any).

NO No information required


Italy YES

1. Full Name

2. Valid Letter of Authorization (FADV LOA)

3. Date of Birth

4. Italian Codice Fiscale Italian Tax Number

5. Address in Italy

*The turn-around-time for Italy check is 22 business days.

NO


Japan YES

1. Complete and return ‘Japan Letter of Authorisation form’. All

information must be in English and Japanese

2. To provide Complete Japan Residential Address and Full Name (in

both English and Kanji), Date of Birth.

3. Japan Passport Number (if available).

4. Name in ‘Kanji’ or ‘Katakana’

NO


Full Name (in Kanji or Katakana and English):

Date of Birth (in Kanji or Katakana and English):

Address in Japan (in Kanji or

Katakana and English):

Passport Number:

Korea YES

1. Complete and return the Korea Credit Consent Form

2. Korean National Identity Number.

3. Complete Korea Residential Address, Full Name, Date of Birth.

NO


Korean Identification Nunber:

Malaysia YES

1. For Malaysia Citizen, to provide Malaysia National Identity Number

(Both Old and New), Full Name, Date of Birth, complete Malaysia

address.

Note – Malaysian born before year 1977 will need to provide Old National

Identity Number.

2. For foreigners, to provide a copy of Passport.

NO


Malaysian Identity Card No:

Mauritius YES

1. To provide complete Mauritius Residential Address with period

of stay, Full Name, Date of Birth

NO



Netherlands YES

1. To provide complete Netherlands Residential Address with period of

stay, Full Name, Date of Birth, Netherlands National Identify

Number.

NO


New Zealand YES

1. Complete and return the New Zealand Criminal Check Form ie.

Ministry of Justice (MOJ) & NZ FADV Form.

2. Photo and signature pages of Passport or Driving License copy.

NOTE: Name and Signature on the form should be identical to that on the ID

provided and the form should contain at least 1 NZ address. In case, the

passport/driving license does not contain signature or hire does not hold

either of the said IDs, hire would need to complete Proof of Identity

form on page 3 section 4 of the MOJ form, signed by a witness.

NO


Nepal YES

1. For Nepal Citizen, to provide complete Nepal Residential Address

with period of stay, Full Name, Date of Birth, Father’s Full Name.

2. For Foreigners, to provide a copy of passport, complete Nepal


NO


Pakistan YES

1. To provide complete Pakistan Residential Address (previous &current)

2. Period of Stay at each address

3. Full Name

4. Date of Birth

5. Fathers full name

6. Pakistan Computerised National Identity Card Number (CNIC).

7. A copy of Transcript of Record and Degree Certificate (applicable to

cases with academic checks).

NO


Pakistan residential address

(in full):

Pakistan National ID

Panama YES

1. Subject’s Full name

2. DOB

3. Mother's Maiden Name

4. Father's complete name

5. Full Address in Panama with Postal code

6. Passport # or International ID

7. Signed general release Form


NO


Peru YES

1. To provide complete Peru Residential Address, Full Name, Date of

Birth.

2. To provide Mother’s Maiden Name.

NO


Philippines YES

1. To provide complete Philippines Residential Address, Full Name, Date

of Birth.

2. To submit Original NBI Certificate.

3. A copy of Degree Certificate or Transcript of Record (applicable to

cases with academic checks).

NO


Singapore YES

1. For Singapore Citizen, to provide National Identity Number.

2. For Foreigners, to provide Foreign Identification Number (FIN), copy

of passport.

NO


Singapore NRIC or FIN

Nunber:

Sri Lanka YES

1. Full Name

2. Date of Birth

3. To provide complete Sri Lanka Residential Address with period of stay

NO No information required

South Africa YES

1. Full Name

2. Date of Birth

3. Complete South Africa address along with period of stay

4. A clear scanned copy of South African ID (for South Africa citizen)

5. A clear scanned copy of Passport (for non South Africa citizen)

NO


Spain YES

1. To provide complete Spain Residential Address, Full Name, Date of

Birth, Spain National Identity Number.

NO



Sweden YES

1. To provide complete Sweden Residential Address, Full Name, Date

of Birth, Sweden National Identity Number.

NO


Switzerland YES

1. To provide complete Switzerland Residential Address with period of

stay, Full Name, Date of Birth, Martial Status.

2. To provide Full Name of parents.

3. To provide Mother’s full maiden name.

4. To provide a copy of passport or National Identity Card. NOTE : Upon receipt of PES request, Asia PES shall apply for a personalized computer generated Switzerland Criminal Consent Form from the local authority. The form will then be provided to the candidate to sign and return to Asia PES for the check to commence.

NO


Taiwan YES

1. For Taiwan Citizen, to provide Full Name (English and Chinese

Characters), Taiwan National Identity Number, Date of Birth.

2. For Foreigners, to provide a copy of passport, complete Taiwan


NO


Taiwan Identity Number:

Name in Chinese characters:

Thailand YES

1. For Thailand Citizen, to provide a copy of Thailand National Identity

Card.

2. For Foreigners, to provide a copy of passport, complete Thailand


NO


Thai Passport No:

Name in Thai Characters:

United

Kingdom

YES 1. To provide complete UK Residential Address, Full Name, Date of

Birth.

NO


UK residential address (in

full):

USA YES

1. To provide complete US Residential Address, Full Name, Date of

Birth.

2. To provide US SSN (if any).

NO


Social Security Number:

US residential address (in

full):

Australian Federal Police Office use only National Police Check (NPC) Application Form

Please complete this form by referring to the Application Completion Guide.

1. Purpose of NPC Code Number: 30 Enter the relevant code number from the table at Section 1: Purpose of NPC on

the Application completion Guide (e.g. Fire fighting/prevention = Code No 15) If a code is not specified this application will be processed as a Standard Disclosure (Code 30). If the purpose is not listed or you are unsure please ring the AFP Criminal Records Help Desk on 02 6202 3333 for assistance.

2. Applicant Details Use BLOCK LETTERS and black ink. Mark check boxes with a cross (X). Current Family Name All Given Names Date of Birth (DD/MM/YYYY) / / Gender: Male Female: Previous or Other Names by which you are known or have been formerly known must be listed below (eg. maiden, deed poll). If more room is required, list on separate sheet, sign and send with this application form. Additional information sheet included Family Name: (include all name changes and maiden name) Given Names Date of Birth

/ /

/ /

Place of Birth Town State Country Telephone Numbers: Home Work Mobile Australian Drivers Licence Number Issuing State: Copy Attached

Current Residential Address – Complete in FULL Unit No. Street No. Street Name / Street Type

Suburb/City Post Code

State Country Residency From

/ / Previous Residential Address – Complete in FULL Unit No. Street No. Street Name / Street Type



/ /

Form CR500m Version 1.05 Page 1 of 4

Previous Residential Address – continued If more room is required, list on separate sheet, sign and send with this application form. Additional information sheet included Unit No. Street No. Street Name / Street Type



/ /

Unit No. Street No. Street Name / Street Type



/ /




/ /




/ /




/ /


3. Employer/Organisation Details (For use by AFP Account holders only) Organisation/employer name Client Code: Client Reference Number

FIRST ADVANTAGE AUSTRALASIA 5012 4. Mailing Address for Police Certificate The National Police Certificate will be posted to the account holder listed at Section 3 of this application. 5. Fingerprints Please note that a fingerprint check is only required under very limited circumstances. Please ensure that you are actually required to have a fingerprint check conducted before going to the expense of this level of check by checking with the organisation/department requesting the check.

Is a fingerprint check required? Yes No If yes, fingerprints must be submitted with this form. In addition choose only one of the below statements. For information on fingerprint checks see Section 5: Fingerprint Checks on the Application Completion Guide. I have attached:

(a) fingerprints taken by another police jurisdiction OR

(b) fingerprints taken by the AFP and not charged when taken OR

(c) fingerprints taken by the AFP and charged when taken - receipt of payment must be supplied with this form 6. Consent

i. I acknowledge I have read the Application Completion Guide for this application form (pages 3 – 6) and I am aware exclusions from spent convictions legislation may apply to some categories of NPCs.

ii. The personal information I have provided on this form (including fingerprints if supplied) relates to me and is correct. iii. I acknowledge the details contained on this form, including fingerprints where relevant, will be forwarded to the AFP, CrimTrac, and/or the

Police Services of the States or Territories of the Commonwealth of Australia. iv. I consent to the AFP and any other Australian police force extracting details of any convictions, findings of guilt or pending court proceedings

relating to me, including in relation to any traffic offence, and providing that information to me or to the Employer/Organisation named in Section 3 above, as approved or to another person agency as named in Section 4.

v. I acknowledge the information provided on this form will not be used without my prior consent for any other purpose, unless otherwise authorised by law.

vi. I acknowledge that any information provided on this form or disclosed by the police as a result of the records check may be taken into account by the organisation mentioned in (3) above or any organisation to whom I present the results of the records check in assessing my suitability to receive the entitlement.

Applicant’s Signature

Date / /

If you are under 18 years of age please provide consent below from a parent/guardian.

Parent/Guardian Signature

Date / /

Parent/Guardian name printed in full


Spent Convictions Legislation The aim of spent convictions legislation is to prevent discrimination on the basis of certain previous convictions. Spent convictions legislation limits the use and disclosure of older, less serious convictions and findings of guilt. There are some offences excluded from being spent where the check is required for certain purposes as indicated in the table above – these offences will be released regardless of how old they are. Where a record exists within an Australian police jurisdiction, relevant spent conviction legislation/policies governing the release of that information for that jurisdiction will be applied. As a result certain convictions will not be released provided this is in accordance with the relevant legislation/policies. For Commonwealth records the AFP applies the provisions within Part VIIC of the Crimes Act 1914 and for ACT records provisions within the ACT Spent Convictions Act 2000 are applicable. If further information or clarification is required please contact the individual jurisdiction where the record is held. Provision of False or Misleading Information You are asked to certify that the personal information you have provided on this form is correct. Where your check is for employment related purposes and the result is to be provided to your employer or other organisation, discovery of any false or misleading information may be reported by the AFP and may impact on the decision being undertaken by the employer or organisation. The AFP provides information, with your consent, to the employer or organisation but takes no part in any subsequent assessment. Disputed Record Enquiries If you believe the information provided on your police certificate is incorrect or inaccurate a Disputed Record form (CR 1200) is available from the AFP website. This form should be forwarded to the AFP through the agency or organisation with whom you have lodged your application for a National Police Check. Include any additional information or documents supporting your enquiry to enable the AFP to more accurately assess your application. In some instances the AFP may require comparison fingerprints to resolve some disputes. Applicants will be notified in such instances. The Privacy Commissioner is responsible for ensuring the protection of private information relating to individuals. This includes investigating instances where information has been released improperly or incorrectly. An individual who believes the standards dealing with disclosure and use of old conviction information have been breached may apply to the Privacy Commissioner for an investigation of the matter. The phone number is 1300 363 992. The following requirements must be met when submitting an AFP National Police Check (NPC).


PRIVACY STATEMENT Our commitment First Advantage Australia Pty Ltd ACN 101 863 209 & First Advantage New Zealand Limited ("First Advantage", "we", "us" or "our") are background screening service providers. We have been engaged by your prospective or current employer, contractor of your services, or landlord (the Requestor) to conduct background checks and to verify the information you have or may provide in applying for employment/engagement or housing with the Requestor. Some of this information may be "personal information" for the purposes of the Australia and New Zealand Privacy Acts: Privacy Act 1988 (Cth) (the Act) & Privacy Act 1993 No. 28 (Act)."Personal information" is defined (i) under the Australia Privacy Act , as "information or an opinion (including information or an opinion forming part of a database), whether true or not, and whether recorded in a material form or not, about an individual whose identity is apparent, or can reasonably be ascertained, from the information or opinion", and (ii) under the New Zealand Privacy Act, as “Information about an identifiable individual; and includes information relating to a death that is maintained by the Registrar‐General pursuant to the Births, Deaths, Marriages, and Relationship Registration Act 1995, or any former Act”. We recognise the importance of privacy issues and respect the confidentiality of the personal information you provide to us. We will deal with your personal information in accordance with the Australia Privacy Act, the National Privacy Principles (NPP’s) and New Zealand Privacy Act, Information Privacy Principles (IPPs) established by the Act(s), our Privacy Policy and Privacy Statement (both as amended from time to time). This Privacy Statement is to be read in conjunction with our Privacy Policy. Should there be any difference between them, the provisions of the Privacy Statement will prevail. Purpose of collecting Information In this form, you have been asked by the Requestor to provide information regarding your background and/or the employment/engagement request you made to the Requestor. Depending on the position of employment/engagement you are applying for or your new role in your organisation, the Requestor may be required by law to determine your suitability for the position, for example under the Corporations Act 2001 (Cth) and/or the Anti‐Money Laundering and Counter‐Terrorism Financing Act 2006 (Cth) and Anti‐Money Laundering and Countering Financing of Terrorism Act 2009. The Requestor has engaged First Advantage to verify the information and responses you provided by arranging for us to carry out verification checks in order to assist the Requestor to determine your suitability for (i) employment/engagement pursuant to their legal obligations and/or internal risk management policy or (ii) rental of a dwelling pursuant to their internal risk management policy. In order to process and verify your application, the Requestor and First Advantage may collect your personal information (including but not limited to information relating to your background, character and personal reputation) and, if necessary, use some or all of the collected personal information to collect additional personal information from various other entities (the Sources). Examples of Sources include, but are not limited to, government agencies, law enforcement bodies, publicly available records, public registries, court or tribunal records, ratings agencies, educational institutions, and regulatory and licensing bodies. First Advantage may report the findings of its investigations to the Requestor via a secure means. We may also collect other Personal Information which is sensitive information (e.g. criminal records) for the same purpose. Any sensitive information we collect will be carried out in accordance with the NPP’s. We may, from time to time, need to collect information about you from a third party you refer to us. When we obtain personal and other information from third parties to whom we are referred by you, we will assume that you have referred First Advantage to them and informed them of the purposes involved in the collection, use and disclosure of the relevant personal or other information.

If you do not consent to provide the personal information requested, we may not be able to verify details for your employment/engagement application and the Requestor may not be able to proceed with the application process. Use and disclosure of your information We may use and disclose the information and documentation and any responses you have provided to apply to the Sources for verification of the personal and other information you or a third party has provided, and to conduct public record searches. Depending on the background checks required by the Requestor and information you supply in this form, we may also conduct background checks on your employment/engagement history and references (with the exception of your current employer/engager, unless you have authorised such contact or commence employment/engagement with the Requestor), education, professional qualifications, residency, sanctions, immigration status, criminal records, claims, judgments, current and previous directorships, character, personal reputation, and conduct such other checks and enquiries as the Requestor considers necessary to verify information provided by you in your employment/engagement application or rental application. The personal information you provide and any other personal information provided by the Sources as a result of the verification process will be processed and provided by us to the Requestor, who may then use this information to consider your suitability for employment/engagement or the change in level of responsibility, or rental of a dwelling, or to determine if further verification or investigation is necessary. If you are currently or subsequently employed/ engaged, this information may become part of your employment/engagement records. In the event that you are offered employment/engagement with the Requestor, we may be requested to obtain an employment/engagement report or investigative report in connection with subsequent employment/engagement decisions. We may, from time to time, need to retain personal information collected from you and the Sources to comply with our contractual, statutory or other legal obligations even after the employment/engagement application process or the rental application process is completed or terminated. Overseas Transfers of Personal Information We will only transfer personal information overseas if: we reasonably believe that the recipient of the information is subject to a law or a contract that effectively upholds privacy principles similar to the NPP's and/or IPPs; you have consented to the transfer; the transfer is necessary for us to provide the Client with their requested service; it is not practical to obtain your consent, the transfer is for your benefit and your consent would likely be given; or we have taken reasonable steps to ensure that your personal information will not be held, used or disclosed by the recipient in a manner inconsistent with this Privacy Policy and the NPP's and/or IPPs.

Access and correction of information If you wish to obtain access to your personal information which is held by us, you may apply for access by contacting the Privacy Officer at the contact details set out in this Privacy Statement. Certain additional terms and conditions may be applicable to provide you with access to your personal data, like requiring proper proof of identification like a government picture ID, prior to providing you access with your personal information. We will handle requests for access to your personal information in accordance with the NPP’s. However, in some circumstances permitted under the NPP’s, we may not be required to give you access to the information we hold about you. It is important to us that the personal information we hold about you is accurate, complete and up to date. If you are aware that this is not the case and would like to correct your Personal Information, you may lodge a correction request by contacting the Privacy Officer at the contact details listed in this Privacy Statement. Please note that the Privacy Officer listed below handles requests from Australia and New Zealand. First Advantage will make all

reasonable efforts to correct the information. However, if applicable, we will also direct you to the source of the information for correction. Any complaints about a breach of privacy will be dealt with in accordance with our Privacy Policy. If you have a complaint about the way First Advantage has dealt with your personal information, or you would like a copy of the Privacy Policy, please contact our Privacy Officer at: The Privacy Officer First Advantage PO Box 455 North Sydney NSW 2059 Tel: + 61 2 9017 4300 Details of our Privacy Policy are also available at www.FADV.com/au. If you are unsatisfied with the outcome, you may refer the matter to the Privacy Commissioner at: Australian Residents: Website: www.privacy.gov.au Tel: 1300 363 992 New Zealand Residents: Email: [email protected] Tel: 04‐474 7590 CONSENT TO COLLECTION, USE AND STORAGE OF INFORMATION Declaration: I ....................................................................................................................................................... ,

(Enter your full, legal name, as per your identification document in BLOCK letters) authorise the Requestor, First Advantage, and any of its/their related entities and affiliates, and any persons or organisations acting on its/their behalf to take steps to verify the information and documentation presented in my application. I acknowledge and agree that this process involves the Requestor, First Advantage, and any of its/their related entities and affiliates, and any persons or organisations acting on its/their behalf collecting, using and/or disclosing, and retaining my personal information in the manner described in the Privacy Statement above. I also acknowledge and agree that First Advantage will be using some of its related entities and affiliates to process this request and that my personal information will be provided to them in order to carry out my background search. I hereby release from liability First Advantage, its related entities and affiliates and their respective employees requesting or supplying such information, if done so in accordance with the First Advantage Privacy Statement and Policy and applicable laws. I understand that my employment/engagement with the Requestor may be terminated with immediate effect should any information provided herein be proven untrue. I also agree that all information and documents provided to the Requestor and First Advantage in my application, can be used to carry out the required background check, including identification documents supplied. I also consent to First Advantage retaining Personal Information collected from me and the Sources to comply with their contractual, statutory or other legal obligations, even after the employment/engagement application process is completed or terminated. (Candidate) ‐ Please Sign: _____________________________________________

Date: ______________________________(DD / MM / YYYY)

Last updated: 21-Jan-10

THE FOLLOWING MUST BE COMPLETED BY THE APPLICANT ONLY IN UPPER CASE LETTERS

I,____________________, have applied for employment with _______________________________________________ (“the Company”). I understand that a condition of employment is verification of my credit and criminal backgrounds, to the satisfaction of the Company. I hereby grant authorization to the holder(s) of information relating to the above items to disclose this information at anytime to the Company and/or to its authorized agent, First Advantage. I understand that the Company will use the results of its inquiry into my full criminal record and credit record (obtained from Trans Union or Equifax), histories in order to confirm my suitability for employment. I understand that the criminal record search being completed is done through First Advantage by an authorized Canadian Police Information Centre (CPIC) Agency (police service) and is a name and date of birth search against the National Criminal Records (NCR) repository, maintained by the Royal Canadian Mounted Police (RCMP) and is not based on fingerprints. I acknowledge a confirmation of my identity can only be obtained through a fingerprint comparison. This search may not include local indices and may or may not reveal criminal record convictions that have not been reported to the NCR repository. I hereby release and forever discharge the holder(s) of information relating to the above items, including the police agency and the RCMP, First Advantage, and the Company, and their respective affiliated entities and all of their former, current, and future partners, directors, officers, employees, agents, successors and assigns, including those belonging to their respective affiliated entities, from any actions, claims, and demands of any kind whatsoever in any way relating to the collection, disclosure, or use of this information by the holder(s) of information relating to the above items, First Advantage or the Company. I further declare that the information below, on my résumé/application, and provided verbally to the Company, is complete and accurate. I understand a false statement will disqualify me from employment and give the Company cause for my dismissal if I am employed. Position being applied for: _____________________________________________ Employment � Volunteer � Contractor � Name |__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__| First Name Middle Name |__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__| Last Name Maiden/Previous/Alias Names |__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__| First Name Last Name Gender: M F Place of Birth |__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__| (Required for Criminal Check) (Required for Criminal Check) Address: |__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__| Number and Street Name City Province/State Postal/Zip Code Previous Addresses If Current Is Less Than 5 Years:

|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__| Number and Street Name City Province/State Postal/Zip Code

|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__| Number and Street Name City Province/State Postal/Zip Code Social Insurance Number |__|__|__|__|__|__|__|__|__| Birth Date: |__|__| |__|__| |__|__|__|__| (Optional) (Required for Criminal Check) DD MM YYYY Driver’s License Number and Province of Issue |__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__| (Required for driver record search) Applicant’s Signature: ______________________________ Today’s Date: DD |__|__| MM |__|__| YYYY |__|__|__|__|

I, _______________________________(PRINT WITNESS NAME) have witnessed the applicant complete this form and provide two

pieces of identification, one of which is government issued photo ID. I have verified the name, date of birth and signature information

provided above against the ID presented and legible copies of the ID viewed are attached with this consent.

Witness Signature________________________________________ Today’s Date: DD |__|__| MM |__|__| YYYY |__|__|__|__|

FOR CRIMINAL CHECKS ONLY: THE FOLLOWING MUST BE COMPLETED BY A REPRESENTATIVE OF THE COMPANY

Canada Criminal Check

QR Form 101

People’s Republic of China Personal Details Sheet for Screening Purposes for P RC citizens

中国公民个人资料表格中国公民个人资料表格中国公民个人资料表格中国公民个人资料表格

((((适用于聘用前调查适用于聘用前调查适用于聘用前调查适用于聘用前调查))))

Please complete all requested details in Chinese. 请用中文中文中文中文填写以下资料，勿留空项勿留空项勿留空项勿留空项。 Name in Chinese and Former Name (if applicable) (中文姓名及曾用名)

PRC Identity Number and DOB (中国身份证号码及出生日期)

身份证号码. (Identity No) : 出生日期 (Date of Birth: yy-mm-dd) :

Hukou Address, Name of Police Office and Hukou Type (详细户口所在地址，管辖派出所

及户口类型)

户口地址 (Hukou Address)：

管辖派出所 (Name of Police Office) ：

户口类型 (Hukou Type)

○ 集体户口集体名称 (Group Name)：

○个人户口 (Individual)

Entity that holds the official personal record file, Contact information & File No. (人事档案所在单位包括名称、电

话，存档号码及存档类型)

名称 (Entity Name)：

电话(Tel no)：

○ 以个人名义存档，存档号码 (Personal File is kept by yourself, File No)：

○ 以雇主名义存档，雇主名称 (Personal file is kept by your employer,

Employer’s Name)：

Can a reference be taken now? (目前可否与该单位核实)? If no, when can it be taken? (如否，何时可与该单位联系)?

○Yes (是) ○ No (否)

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 (Name of Institution)：

系别、专业 (Major/Area of Specialization)：

年级、学号 (Class Last Attended, Student No)：

已获或将获学位 (Qualification obtained)：

授授授授权权权权书书书书

致有关人士：

本人授权此授权书的持有人对本人在职位申请表及个人履历中所提供的信息在其认为必要时进行核

实。于核实有无犯罪记录时，请有关部门和单位予以配合。

本人授权持有或了解有关情况的人士向此授权书持有人如实披露有关情况。本人免除其因此而可能产

生的责任。

姓名 Signed in Chinese

：______________

日期 Date

：______________

China Form

QR Form 101

English Translation (for reference only)

Letter of Authorization To Whom It May Concern: I hereby provide my authorization to the Bearer of this Letter to verify information provided in my resume and application of employment and to conduct enquiries as may be necessary, at the Bearer’s discretion. Should the Bearer make application to the relevant department for a criminal record check, please do not hesitate to help. I authorize all persons who may have information relevant to this enquiry to disclose it to the Bearer of this letter. I release all persons from liability on account of such disclosure.”

China Authorisation Form

STUDENT AUTHORIZATION

To: Registration and Examinations Section, The Chinese University of Hong Kong

I hereby give authorization to your disclosure of my personal data to First Advantage – Employment Screening Services Division – 10/F The Paragon Corporate Centre, Industry Street, Madrigal Business Park, Alabang, Muntinlupa City 1780, Philippines.

Name of Student: Signature:

CUHK Student No.:

Date:

Hong Kong Identity Card No.* : * This data requested for checking purpose only and will be treated as confidential information.

REQUEST FOR PERSONAL DATA AND UNDERTAKING Part I

I/We hereby request personal data concerning

name of subject :

personal data requested :

acknowledging that this information is required for the following purpose only

purpose for which the personal data is required :

UNDERTAKING

that this is a purpose authorised by law subject to the consent of the data subject having been first received;

that this personal data will be used for no other purpose than that stated herein; and

that this personal data will not be transferred to unauthorised third parties.

Name of Person/Company Authorised Signature and/or Seal

Official Title or Office Date Part II

(To be filled in by the data subject)

The Registrar

The Open University of Hong Kong

30 Good Shepherd Street

Homantin, Kowloon

Release of Personal Data I* agree/do not agree to your release of my personal data to the person/company named above for the purpose stated

therein.

Name in English Signature

Identity Number Date *Please delete as appropriate

LETTER OF CONSENT AND AUTHORIZATION

To whom may it concern, Under Articles 23-1 and 29-3 of the Personal Information Protection Act, I hereby agree to allow First Advantage Japan to verify my personal details and the information provided in my resume and application for employment, which I submitted to First Advantage Japan, to conduct enquiries (including allowing First Advantage Japan to provide Personal Information to a third party where necessary) as may be necessary, at the company’s discretion. And I hereby authorize First Advantage Japan to require the disclosure of the Retained Personal Data (defined in the Personal Information Protection Act) to any entities which have Personal Information. I agree and authorize all persons who may have information relevant to this enquiry to disclose it directly to my agents, First Advantage Japan. I release persons from any liability on account of such disclosure. Name in Block Capitals :

Last Name First Name Middle Name

Date of Birth : / / MM / DD / YY

Signature Date ( MM / DD / YY ) Personal Hanko (if applicable)

同意書及同意書及同意書及同意書及びびびび委任状委任状委任状委任状

関係者各位

ここに私（以下、甲）は個人情報保護法第 23 条 1 項及び第 29 条 3 項に基づき、ファースト・アドバンテージ・ジャパン（以下、乙）に対して、甲が乙に提出した履歴書や就職願書に記されている事項（以下、個人情報）の判断に必要な調査すること（必要な第三者に個人情報を開示することを含む。）、又、必要であれば乙の意思で追加調査すること（必要な第三者に個人情報を開示することを含む。）に同意します。また甲は、乙に対し、個人情報保護法第 25条 1項に基づく情報保持者に対する保有個人データ（個人情報保護法に定義される。）の開示請求を行うことを委任いたします。甲は調査に対する情報保持者が甲の代理人である乙に対し情報を直接提供することを認めます。甲はこの調査の結果甲に損害が生じた場合に関して情報提供者に一切の責任を問いません。

名前：氏名

生年月日： / / （月 / 日 / 年）

/ / 署名日付（月 / 日 / 年）印

Japan Authorisation Form

Private & Confidential

CONSENT TO CONDUCT A CREDIT CHECK – NEW ZEALAND

Declaration: I ______________________________________________ (Full name in BLOCK letters) authorise the Employer, First Advantage, and any of its/their related entities and affiliates, and any persons or organisations acting on its/their behalf to collect, to retain and disclose personal information about me in accordance with the Privacy Act 1993.

Information may be collected from one or both of the following agencies:

Veda Advantage (NZ) Ltd

Dun and Bradstreet (NZ) Ltd

I understand that the position which I have applied for involves significant financial risk and I therefore authorise the following:

• Veda Advantage (NZ) Ltd and/or Dun and Bradstreet (NZ) Ltd to provide First Advantage information about me for the purpose of a pre-employment check for a position involving significant financial risk;

• First Advantage to provide my personal information to Veda Advantage (NZ) Ltd and/or Dun and Bradstreet (NZ) Ltd, and that I agree that Veda Advantage (NZ) Ltd and/or Dun and Bradstreet (NZ) Ltd will hold that information on their systems and use it to update their credit reporting service.

• When other Veda Advantage (NZ) Ltd and/or Dun and Bradstreet (NZ) Ltd customers use the Veda Advantage (NZ) Ltd and/or Dun and Bradstreet (NZ) Ltd credit reporting service, Veda Advantage (NZ) Ltd and/or Dun and Bradstreet (NZ) Ltd may provide the updated information to those customers.

(Candidate) - Please Sign: _____________________________________________ Date: ______________________________(DD / MM / YYYY)

IN-CONFIDENCE WHEN COMPLETED

Privacy Unit

Ministry of Justice

National Office

P O Box 2750

WELLINGTON

REQUEST BY THIRD PARTY UNDER THE OFFICIAL INFORMATION ACT 1982 FOR A COPY OF AN INDIVIDUAL'S

CRIMINAL CONVICTIONS HELD ON THE MINISTRY OF JUSTICE 'S COMPUTER SYSTEMS

I hereby authorise the Privacy Unit, Ministry of Justice, to release a copy of my personal information, to the undersigned

Third Party, for the purpose of:

Full Name of Third Party

Third Party Name Details

Suburb

City

State / Province

Post Code

Country

Page 1 of 3 Form continues overleaf

X

Signature of subjec t and date

SECTION 1: SUBJECT'S AUTHORITY TO RELEASE INFORMATION TO A THIRD PARTY

Full name and address of the person or agency the third party is acting for

(if applicable)

Third Party Address Details

X

Signature of Third Party

SECTION 2: THIRD PARTY DETAILS

I wish to receive a copy of the

information provided to the Third party. Yes / No

The Ministry of Justice will process this request as soon as is reasonably practicable, and in any case no later than 20

working days from receipt of this application.

This application and associated letters and reports will be disposed of three months after processing the response.

Pre-employment vetting

Other (specify) X

The term "subject" refers to the person whose criminal convictions is being requested.

The term "third party" refers to the requestor or ultimate intended recipient, such as an employer, insurance

company, credit agency et cetera.

For Office Use Only

MoJ Request Number

Priv/F2

Third Party Reference Number

(if applicable)

Insurance Claims vetting

All convictions report Traffic Convictions Report

Tick the report required:

Street AddressP.O. Box or

91674

Auckland

1142

New Zealand

First Advantage

NA Warrick Harkness

7147

Tikipung

Whangerei

0144

Tikipunga

Whangarei

Surname First Name Middle Names (separate by comma)

Date of Birth (DD/MM/YYYY) Place of Birth Gender (Male / Female)

Personal Details


Suburb

City

State / Province

Post Code

Country

Previous Names - Maiden Name, Aliases

Postal Address

SECTION 3: SUBJECT'S DETAILS (Please print in pen)

Page 2 of 3 Form continues overleaf

Current Residential Address

Street Address

Suburb

City

State / Province

Post Code

Country

Previous Two Residential Addresses

Street Address

Suburb

City

State / Province

Post Code

Country

Street Address

Suburb

City

State / Province

Post Code

Country

Daytime Phone Number

Home Phone Number

Fax Number

Priv/F2

Street AddressP.O. Box or

Please attach a photocopy of the subject's identification. The identification may be a Driver Licence OR if subject does

not hold a driver licence, a Passport. If subject has neither, the subject will need to complete Section 4.

Subject's Identification

Driver Licence Passport

Page 3 of 3

Street Address

Suburb

City

State / Province

Post Code

Country

SECTION 4: PROOF OF IDENTITY

ONLY TO BE COMPLETED IF SUBJECT DOES NOT HAVE A DRIVER LICENCE OR PASSPORT

Subject to ask someone who can confirm their identity to fill in th is section

The person who identifies sub ject must:

- have known subject for more than 12 months

- be aged 18 years or over

- have a day time phone number

- not be a relative

- not live at the same address

- be contactable during normal business hours


I declare that I have personally known:


for years and vouch for his/her identity X

Signature of identifier

If subject is unable to get someone to complete Section 4, they must complete a statutory declaration. The relevant

form can be obtained from the local District Court or by contacting the Privacy Unit on 04 918 8800.

SECTION 3: SUBJECT'S DETAILS (continued)

Home Phone Number

Fax Number

Daytime Phone Number

Priv/F2

PRIVACY STATEMENT Our commitment First Advantage Australia Pty Ltd ACN 101 863 209 & First Advantage New Zealand Limited ("First Advantage", "we", "us" or "our") are background screening service providers. We have been engaged by your prospective or current employer, contractor of your services, or landlord (the Requestor) to conduct background checks and to verify the information you have or may provide in applying for employment/engagement or housing with the Requestor. Some of this information may be "personal information" for the purposes of the Australia and New Zealand Privacy Acts: Privacy Act 1988 (Cth) (the Act) & Privacy Act 1993 No. 28 (Act)."Personal information" is defined (i) under the Australia Privacy Act , as "information or an opinion (including information or an opinion forming part of a database), whether true or not, and whether recorded in a material form or not, about an individual whose identity is apparent, or can reasonably be ascertained, from the information or opinion", and (ii) under the New Zealand Privacy Act, as “Information about an identifiable individual; and includes information relating to a death that is maintained by the Registrar‐General pursuant to the Births, Deaths, Marriages, and Relationship Registration Act 1995, or any former Act”. We recognise the importance of privacy issues and respect the confidentiality of the personal information you provide to us. We will deal with your personal information in accordance with the Australia Privacy Act, the National Privacy Principles (NPP’s) and New Zealand Privacy Act, Information Privacy Principles (IPPs) established by the Act(s), our Privacy Policy and Privacy Statement (both as amended from time to time). This Privacy Statement is to be read in conjunction with our Privacy Policy. Should there be any difference between them, the provisions of the Privacy Statement will prevail. Purpose of collecting Information In this form, you have been asked by the Requestor to provide information regarding your background and/or the employment/engagement request you made to the Requestor. Depending on the position of employment/engagement you are applying for or your new role in your organisation, the Requestor may be required by law to determine your suitability for the position, for example under the Corporations Act 2001 (Cth) and/or the Anti‐Money Laundering and Counter‐Terrorism Financing Act 2006 (Cth) and Anti‐Money Laundering and Countering Financing of Terrorism Act 2009. The Requestor has engaged First Advantage to verify the information and responses you provided by arranging for us to carry out verification checks in order to assist the Requestor to determine your suitability for (i) employment/engagement pursuant to their legal obligations and/or internal risk management policy or (ii) rental of a dwelling pursuant to their internal risk management policy. In order to process and verify your application, the Requestor and First Advantage may collect your personal information (including but not limited to information relating to your background, character and personal reputation) and, if necessary, use some or all of the collected personal information to collect additional personal information from various other entities (the Sources). Examples of Sources include, but are not limited to, government agencies, law enforcement bodies, publicly available records, public registries, court or tribunal records, ratings agencies, educational institutions, and regulatory and licensing bodies. First Advantage may report the findings of its investigations to the Requestor via a secure means. We may also collect other Personal Information which is sensitive information (e.g. criminal records) for the same purpose. Any sensitive information we collect will be carried out in accordance with the NPP’s. We may, from time to time, need to collect information about you from a third party you refer to us. When we obtain personal and other information from third parties to whom we are referred by you, we will assume that you have referred First Advantage to them and informed them of the purposes involved in the collection, use and disclosure of the relevant personal or other information.

If you do not consent to provide the personal information requested, we may not be able to verify details for your employment/engagement application and the Requestor may not be able to proceed with the application process. Use and disclosure of your information We may use and disclose the information and documentation and any responses you have provided to apply to the Sources for verification of the personal and other information you or a third party has provided, and to conduct public record searches. Depending on the background checks required by the Requestor and information you supply in this form, we may also conduct background checks on your employment/engagement history and references (with the exception of your current employer/engager, unless you have authorised such contact or commence employment/engagement with the Requestor), education, professional qualifications, residency, sanctions, immigration status, criminal records, claims, judgments, current and previous directorships, character, personal reputation, and conduct such other checks and enquiries as the Requestor considers necessary to verify information provided by you in your employment/engagement application or rental application. The personal information you provide and any other personal information provided by the Sources as a result of the verification process will be processed and provided by us to the Requestor, who may then use this information to consider your suitability for employment/engagement or the change in level of responsibility, or rental of a dwelling, or to determine if further verification or investigation is necessary. If you are currently or subsequently employed/ engaged, this information may become part of your employment/engagement records. In the event that you are offered employment/engagement with the Requestor, we may be requested to obtain an employment/engagement report or investigative report in connection with subsequent employment/engagement decisions. We may, from time to time, need to retain personal information collected from you and the Sources to comply with our contractual, statutory or other legal obligations even after the employment/engagement application process or the rental application process is completed or terminated. Overseas Transfers of Personal Information We will only transfer personal information overseas if: we reasonably believe that the recipient of the information is subject to a law or a contract that effectively upholds privacy principles similar to the NPP's and/or IPPs; you have consented to the transfer; the transfer is necessary for us to provide the Client with their requested service; it is not practical to obtain your consent, the transfer is for your benefit and your consent would likely be given; or we have taken reasonable steps to ensure that your personal information will not be held, used or disclosed by the recipient in a manner inconsistent with this Privacy Policy and the NPP's and/or IPPs.

Access and correction of information If you wish to obtain access to your personal information which is held by us, you may apply for access by contacting the Privacy Officer at the contact details set out in this Privacy Statement. Certain additional terms and conditions may be applicable to provide you with access to your personal data, like requiring proper proof of identification like a government picture ID, prior to providing you access with your personal information. We will handle requests for access to your personal information in accordance with the NPP’s. However, in some circumstances permitted under the NPP’s, we may not be required to give you access to the information we hold about you. It is important to us that the personal information we hold about you is accurate, complete and up to date. If you are aware that this is not the case and would like to correct your Personal Information, you may lodge a correction request by contacting the Privacy Officer at the contact details listed in this Privacy Statement. Please note that the Privacy Officer listed below handles requests from Australia and New Zealand. First Advantage will make all

reasonable efforts to correct the information. However, if applicable, we will also direct you to the source of the information for correction. Any complaints about a breach of privacy will be dealt with in accordance with our Privacy Policy. If you have a complaint about the way First Advantage has dealt with your personal information, or you would like a copy of the Privacy Policy, please contact our Privacy Officer at: The Privacy Officer First Advantage PO Box 455 North Sydney NSW 2059 Tel: + 61 2 9017 4300 Details of our Privacy Policy are also available at www.FADV.com/au. If you are unsatisfied with the outcome, you may refer the matter to the Privacy Commissioner at: Australian Residents: Website: www.privacy.gov.au Tel: 1300 363 992 New Zealand Residents: Email: [email protected] Tel: 04‐474 7590 CONSENT TO COLLECTION, USE AND STORAGE OF INFORMATION Declaration: I ....................................................................................................................................................... ,

(Enter your full, legal name, as per your identification document in BLOCK letters) authorise the Requestor, First Advantage, and any of its/their related entities and affiliates, and any persons or organisations acting on its/their behalf to take steps to verify the information and documentation presented in my application. I acknowledge and agree that this process involves the Requestor, First Advantage, and any of its/their related entities and affiliates, and any persons or organisations acting on its/their behalf collecting, using and/or disclosing, and retaining my personal information in the manner described in the Privacy Statement above. I also acknowledge and agree that First Advantage will be using some of its related entities and affiliates to process this request and that my personal information will be provided to them in order to carry out my background search. I hereby release from liability First Advantage, its related entities and affiliates and their respective employees requesting or supplying such information, if done so in accordance with the First Advantage Privacy Statement and Policy and applicable laws. I understand that my employment/engagement with the Requestor may be terminated with immediate effect should any information provided herein be proven untrue. I also agree that all information and documents provided to the Requestor and First Advantage in my application, can be used to carry out the required background check, including identification documents supplied. I also consent to First Advantage retaining Personal Information collected from me and the Sources to comply with their contractual, statutory or other legal obligations, even after the employment/engagement application process is completed or terminated. (Candidate) ‐ Please Sign: _____________________________________________

Date: ______________________________(DD / MM / YYYY)

Page 1 / 11

Strictly Private and Confidential (when completed)

· [ · , , ,

.] [For the convenience of the candidate, this Consent to Collect, Use and Provide Personal Data Form is being provided both in the English and Korean version. The candidate is therefore advised to sign on either the English or the Korean version.]

EMPLOYEE VETTING · .

[ · ] < >

· : ( ) .

FIRST ADVANTAGE , .

· :

( ), , , , , , , , ,

, , , , , , , , , , .

:

FIRST ADVANTAGE , , 5 .

: (

) .

�� · . �� . < >

· : FIRST ADVANTAGE .

· :

FIRST ADVANTAGE , · .

: , , 5

.

: · (

Page 2 / 8


) .

�� · . �� . [ ] < >

: FIRST ADVANTAGE

.

: ( ), , , , ,

, , , , , , , , , , , , ,

, . [ ]

, FIRST ADVANTAGE . 2

.

: FIRST ADVANTAGE

, EMPLOYEE VETTING . , , FIRST ADVANTAGE

, , . .

[FIRST ADVANTAGE ,

, , , .]

:

FIRST ADVANTAGE 17 , 17 2 , , , , 18 3

21 , , , 5 .

: (

) . , , , ,

. First Advantage .

�� . �� . < >

: FIRST ADVANTAGE

Page 3 / 8


.

: FIRST ADVANTAGE

, .

: FIRST ADVANTAGE

, EMPLOYEE VETTING . , , FIRST ADVANTAGE

, , . .

: , , 5

.

: (

) .

�� . �� .

, , , , ,

.

.

, , , , .

/ Name in Korean:

/ Name in English:

/ / if applicable Previous/Maiden Name:

/ Korean ID Number:

/ Signature:

.

Page 4 / 8


* 10

( . )

* PERMANENT RESIDENTAL ADDRESSES OVER THE LAST TEN YEARS IN KOREA

(Please attach Household Registration Certificate if necessary)

/ Residential Addresses / Period of Residence

(YYYY/MM) ~ (YYYY/MM)

1.

2.

3.

4.

5.

6.

Page 5 / 8


Consent to Collect, Use and Provide Personal Data [For the convenience of the candidate, this Consent to Collect, Use and Provide Personal Data Form is being provided both in the English and Korean version. The candidate is therefore advised to sign on either the English or the Korean version.] To Whom It May Concern The information I have provided on this application is in accordance with my consent to collect, use and provide such information and accurate and does not contain any false information to the best of my knowledge. [CONSENT TO COLLECT AND USE] <General Personal Information> Purpose of Collection and Use: I understand the Company requires certain information as below about me to evaluate my qualifications for employment and to conduct its business if I become an employee. Therefore, I hereby agree that the Company and FIRST ADVANTAGE, the duly authorized agent of the Company for employment screening, collect and use information presented on this form and resume and authorize the Company and FIRST ADVANTAGE to conduct such employment screening. Items to be collected and used: I hereby agree that the background screening mentioned above contains verification of the personal information such as the name (including the English name), mobile phone number, electronic mail address, residence address, nationality and the year of graduation, major, professional qualification and degree awarded for my educational achievements from educational institutions, as well as the verification of my dates of employment, department, job description, salary, reason for leaving, the position/title for my previous employment record held by any company or business for which I worked for in the past, and the name, position, company name, office phone number and mobile phone number of the immediate supervisor for purposes of reference check. Duration of Possession: I understand and acknowledge; that upon completion of hiring evaluation, the Company or FIRST ADVANTAGE will immediately destroy the original copy of the consent form upon my request and that in the case such request is not made, the original copy will be kept for a period of five (5) years. Right to Refuse to Consent to Collection and Use: I acknowledge that I have the right to refuse to consent and that I am aware of the disadvantages (e.g., impossibilities to conduct hiring process and refusal to hire).

�� I hereby consent to the above. �� I do not consent to the above. <Unique Identification Information> Items of Unique Identification Information to be co llected/used: I hereby agree that the Company and First Advantage may collect and use my resident registration number, my unique identification information. Purpose of Collection/Use: I understand that the Company to which I hereby apply and First Advantage, an agent of the Company, requires my resident registration number to identify me and I hereby consent to the collection and use thereof. Duration of the Provision: I understand and acknowledge that the original copy of the consent form may be immediately destroyed upon my request and in the case that such notification is not made, the original copy will be kept for a period of five (5) years. Right to Refuse to Consent: I acknowledge that I have the right to refuse to consent and that I am aware of the disadvantages (e.g., impossibilities to conduct hiring process and refusal to hire).

�� I hereby consent to the above. �� I do not consent to the above.

Page 6 / 8


[CONSENT TO PROVIDE] <General Personal Information> Purpose of Provision: I understand the Company requires certain information as below about me to evaluate my qualifications for employment and to conduct its business if I become an employee. Therefore, I hereby agree that the Company and FIRST ADVANTAGE, the duly authorized agent of the Company for employment screening, verify and investigate information presented on this form and resume and authorize the Company and FIRST ADVANTAGE to conduct such employment screening. Items to be provided: I hereby agree that the background screening mentioned above contains verification of the personal information such as the name (including the English name), mobile phone number, electronic mail address, residence address, nationality and the year of graduation, major, professional qualification and degree awarded for my educational achievements from educational institutions, as well as the verification of my dates of employment, department, job description, salary, reason for leaving, the position/title for my previous employment record held by any company or business for which I worked for in the past, and the name, position, company name, office phone number and mobile phone number of the immediate supervisor for purposes of reference check. [Limited to cases where the Court Record and Credit Record checks are included in the pre-employment screening process] I, hereby authorize FIRST ADVANTAGE on behalf of prospective employer to obtain my personal data including details of court records and credit records for only recrui ting purposes. The credit report will be obtained within a two month period commencing from the date this consent is signed. Receiving Party: I acknowledge that this verification process may involve the transfer of my personal data to FIRST ADVANTAGE offices overseas as well as any business organization affiliated with FIRST ADVANTAGE and my current and previous employers that I described in the EMPLOYY VETTING FORM for the sole purpose of my pre-employment screening, and I hereby consent to such transfer. I voluntarily give my unreserved authorization to any individual, corporation, or other private or public entity to provide the Company and FIRST ADVANTAGE, and their representatives all relevant information about me within the legal boundaries. I acknowledge that when appropriate, this process may include the transfer of my personal data outside of my native country for overseas inquiries and I therefore authorize such transfer to take place. Furthermore, it is within my understanding that contact will be made with my current employer only when I have formally resigned or when I have agreed to the contact in beforehand. [Prior to the overseas transfer of the candidate’s information to either international FADV offices or affiliated organizations, First Advantage will inform the candidate beforehand regarding the name and location of the office/organization and in the process request for the consent to transfer the information in the form of writing, email or fax.] Duration of the Provision: I understand and acknowledge; that FIRST ADVANTAGE will conduct the screening in accordance with Article 17 of the Personal Information Protection Act, Article 17 (2) stating the receiving party of personal information, purpose of personal information usage, forms of personal information, duration and retention of personal information, as well Article 18 (3) and Article 21 which state the safety measures for personal information security, notification for the destroying of personal information, and that the original copy of the consent form may be immediately destroyed upon my request and in the case that such notification is not made, the original copy will be kept for a period of five (5) years. Right to Refuse to Consent to the Provision: I acknowledge that I have the right to practice refuse consent and that I am aware of the disadvantages (e.g., impossibilities to conduct hiring process and refusal to hire). I hereby confirm and agree that any false answers or statements made by me on this form, resume, any supplement thereto may be grounds for refusal of employment, invalidate my employment or, if employed, will be sufficient grounds for disciplinary termination and termination on advice in accordance with the Company Work Rules and may be terminated there under. I hereby acknowledge and understand that FIRST ADVANTAGE will not be legally liable to any degree in the process of

Page 7 / 8


acquiring and submitting my personal information.

�� I hereby consent to the above. �� I do not consent to the above. <Unique Identification Information> Items of Unique Identification Information to be pr ovided: I hereby agree that the information provided to First Advantage may include my resident registration number, my unique identification information. Purpose of Provision: I understand First Advantage, an agent of the Company, requires my resident registration number to identify me and I hereby consent to the provision thereof. Receiving Party: I acknowledge that this verification process may involve the transfer of my resident registration number to FIRST ADVANTAGE offices overseas as well as any business organization affiliated with FIRST ADVANTAGE and my current and previous employers that I described in the EMPLOYY VETTING FORM for the sole purpose of my pre-employment screening, and I hereby consent to such transfer. I voluntarily give my unreserved authorization to any individual, corporation, or other private or public entity to provide the Company and FIRST ADVANTAGE, and their representatives all relevant information about me within the legal boundaries. I acknowledge that when appropriate, this process may include the transfer of my personal data outside of my native country for overseas inquiries and I therefore authorize such transfer to take place. Furthermore, it is within my understanding that contact will be made with my current employer only when I have formally resigned or when I have agreed to the contact in beforehand. Duration of the Provision: I understand and acknowledge that the original copy of the consent form may be immediately destroyed upon my request and in the case that such notification is not made, the original copy will be kept for a period of five (5) years. Right to Refuse to Consent to the Provision: I acknowledge that I have the right to practice refuse consent and that I am aware of the disadvantages (e.g., impossibilities to conduct hiring process and refusal to hire).

�� I hereby consent to the above. �� I do not consent to the above. I understand that in jurisdictions where I have a statutory right, I may request the following in relation to the personal data collected through this process: access to my personal data; supplement or correct t he data collected; erase the data collected; and/or discontinuance of collection , processing, and using of further personal data . I, hereby submit this Consent Form. I hereby further acknowledge that I have obtained consent of my immediate supervisor(s) in connection with the provision of their name(s), position(s), company name(s), and mobile phone number(s) for purposes of reference check described herein.

Name in Korean:

Name in English:

if applicable Previous /Maiden Name:

Korean ID Number:

Signature:

Page 8 / 8


Only those candidates whose pre-employment screenin g process includes the Court

Record Check should fill out the table below.

* PERMANENT RESIDENTAL ADDRESSES OVER THE LAST TEN YEARS IN KOREA

(Please attach Household Registration Certificate if necessary)

Residential Addresses Period of Residence

(YYYY/MM) ~ (YYYY/MM)

1.

2.

3.

4.

5.

6.

Documents

Extra Jurisdiction - Essential Information Checklist OCT2013