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Background Screening Information Form

背景核实信息表

for

上海银行

Important Notice / 重要声明:

1. All question fields in this information form must be completed and answered correctly.

此信息表中所有的问题需全部完成并准确回答。

2. First Advantage will not contact the current employer if it’s stated not to contact now. Please provide a suitable

contact date which should not be later than your onboard date.

如果已声明目前不可以联系当前雇主，首优咨询有限公司不会与该雇主联系。但请提供不晚于您新公司入职日期的联系日。

3. First Advantage does not commit to only contact the provided contact person for background screening. The

provided contact will be used as a reference.

首优咨询有限公司并不承诺只会与所提供的联系人完成背景核实。所提供的信息将作为参考。

4. If you would like First Advantage to only contact the provided contact person, please state the request on the

information form. First Advantage will confirm with its client before making the contact.

如果您希望首优咨询有限公司只与您提供的联系人完成背景核实，请将具体需求写明在信息表中。首优咨询有限公司会先与客户确认后再决定是否可行。

5. All information provided are for background screening purpose only and kept in confidential.

所有提供的信息仅供背景核实使用且严格保密。

6. Once Background Screening is completed, the report will be returned to the HR team for recording.

在背景核实完成后，相关报告会交至人力资源部门存档。

Personal Information: 个人信息

Please give full details of your name and alternatives used where applicable. Known as name should be provided where appropriate.

请提供您的全称及其他曾用名（如适用）。

Family Name (Surname): 姓 王 Date of Birth (Date/Month/Year): Given Name (First_Middle_etc.): 名 菲菲 Gender (Male/Female) : English Name / Other Name 英文名 / 曾用名 Name in other Language (i.e. in Chinese, Japanese etc. characters / Alias, if any) : 中文全名 王菲菲 Current Email Address 现常用邮箱地址 wangfei0517@163.com Nationality 国籍 中国 Cell Phone Number: 手机号码 15001898286 出生日期 17/05/1986 性别 Male (男) Female (女) Country of Issue (Identity Card) 颁发国家 Types of Identity (Identity card/Passport) 证件类型 Identity Card (身份证) 370481198605170927 中国 Passport (护照) * If you have secondary nationality or more, please also provide the Identity Information 如果您有其他国籍，请同样提供相关信息 * Secondary Identity Card No. 第二证件号码 * Country of Issue (Identity Card) 颁发国家 Identity Card No. 证件号码 * Types of Identity * Nationality (Identity card/Passport) 国籍 证件类型 Identity Card (身份证) Passport (护照) In order for the Company to obtain a complete and accurate background history please provide full details below. 为便于取得完整并准确的背景历史，请详细填写以下资料。 Have you lived or worked in the United States during the past 7 years? If yes, Please provide your US US SSN: Social Security Number, and if no, please indicate “no” in the space provided: 您是否在过去7年中在美国居住或工作过？如果是，请提供您的美国社会保险号。如果No 是否，请在右侧空白处写”No” Have you lived or worked in Canada during the past 7 years? If yes, Please provide your Canadian Canadian SIN: Social Insurance Number, and if no, please indicate “no” in the space provided: 您是否在过去7年中在加拿大居住或工作过？如果是，请提供您的加拿大社会保险号。No 如果是否，请在右侧空白处写”No” 1 of 8

Residential Address(es) (please provide all addresses in full indicating clearly Street Name/Number, Country, State & City) : at which you have resided during the past five (5) years, commencing with your current residence. Please indicate the residential period for each address. 居住地址：请将您在过去5年间曾居住超过6个月的详细地址列出，包括您现在的居住地址。 S/N Address (In descending order, 1 being the most current residential address) 地址(按时间顺序倒叙，第一行为最近居住地址) 上海市普陀区靖边路199弄39号1004室 上海市虹口区东体育会路475号 Period of Stay (Years) 居住时间 (年) 1.5 1 1 2 3 上海市徐汇区梅陇路130号 3 4 5 For candidates from Peoples’ Republic of China, please complete below details: 中国籍候选人，请填写以下信息。 Hukou Address (户籍所在地址) Hukou Type (户口类型) Police Station (户籍管辖派出所) Entity that holds the official HR file and file number (人事档案所在单位包括单位名称，地址，电话和存档号) 上海市普陀区靖边路199弄39号1004室 Individual Hukou (个人户口) 上海市普陀区桃浦派出所 Collective Hukou (集体户口) 档案所在单位： 上海宝信软件股份有限公司 档案保管单位地址：上海市浦东新区郭守敬路515号 联系人：朱菁菁 联系电话：20378827 存档号：178571 For PRC Candidates: Please attach a copy of your PRC ID card 中国大陆籍候选人：请附上身份证复印件 For Other Candidates: Please attach a legible copy of your passport which was used when travelling to China 非中国大陆籍候选人：请附上护照复印件 2 of 8