[별지 제22호서식] <개정 2017.2.22.>											(1st page)
PERSONAL QUESTIONNAIRE * FOR OFFICIAL USE ONLY											[PHOTO] or photo file (3㎝×4㎝)ㆍ (3.5㎝×4.5㎝)
NAME	Last/First/Middle					GENDER
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
WORK PLACE				JOB/POSITION
TELEPHONE NUMBERS (Include Area Code)	WORK : MOBILE :
EDUCATION	SCHOOL NAME	PERIOD (MM/YY-MM/YY)			TYPE OF DEGREE			REWARD & PUNISHMENT (MM/YY)				LOCATION (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 (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			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 :