[별지 제22호서식]															(1st page)
PERSONAL QUESTIONNAIRE *THIS INFORMATION IS FOR OFFICIAL USE ONLY															[PHOTO] (3㎝×4㎝)
NAME	Last/First/Middle				DATE OF BIRTH					Month/Day/Year
NATIONALITY (Include any dual nationality)					PLACE OF BIRTH					City/Country
ALIEN REGISTRATION NUMBER					DATE & PLACE OF ENTRY TO KOREA					Month/Day/Year City/Country
ADDRESS											GENDER
WORK PLACE						JOB/POSITION
TELEPHONE NUMBERS (Include Area Code)	HOME : WORK : MOBILE :
BLOOD TYPE		HEIGHT		㎝			WEIGHT		㎏			HAIR COLOR				EYE COLOR
EDUCATION	SCHOOL NAME		PERIOD (MM/YY-MM/YY)					TYPE OF DEGREE					REWARD & PUNISHMENT (MM/YY)				LOCATION (Street Address & City/Country)
210㎜×297㎜ 일반용지 60g/㎡(재활용품)

							(2nd page)
WORK EXPERIENCE AND ACTIVITIES	EMPLOYER/ VERIFIER NAME		PERIOD (MM/YY-MM/YY)		JOB TITLE/ POSITION		LOCATION (Street Address & City/Country)
FAMILY DETAILS	RELATION	NAME Last/First/Middle		DATE OF BIRTH	FINAL ACADEMIC CAREER	CAREER	ADDRESS
RELATIVE & ASSOCIATES IN KOREA	RELATION	NAME Last/First/Middle		DATES KNOWN (MM/YY-MM/YY)	CAREER	JOB TITLE/ POSITION	TELEPHONE NUMBER
I understand that this form may be submitted for checking against the records of police, security and credit agencies in accordance with security policy. I declare that the information I have given is true and complete to the best of my knowledge and belief. I understand that any false statement or deliberate omission in the information I have given in this questionnaire may disqualify me for employment or make me liable to disciplinary action which may include dismissal. DATE : SIGNATURE :

210mm×297mm 일반용지 60g/㎡(재활용품)