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?
. !o you hold citi"enshi# for one or $ore of the below locations?
If ES! pro"ide the re#uested information
$ustralia ES
1. %o$#lete &'ustralian (ederal )olice ('()) %heck* for$
'll fields in the '() for$ are to be co$#leted
+)osition,-ole. refers to the #osition in /)0%
!ates should be in dd,$$,yy for$at
'll addresses #rovided should be indicated with a date #eriod
e.g. 1eorge 2treet, 2ydney (/an 2333 4 /an 2335)
5a$e and 2ignature on the for$ should be identical to that on the I! #rovided.
)hoto and signature #ages of )ass#ort or !riving 6icense co#y

%&
5o infor$ation re7uired

' Important %ote8 '() $ay re7uire u# to to 9 weeks for further investigation of cases with #ossible
cri$inal na$e $atches. 'sia ):2 shall infor$ the re7uestor of such develo#$ents and the intended
onboarding shall be re;scheduled.
$rgentina

ES
1. <o #rovide co$#lete 'rgentina -esidential 'ddress, (ull 5a$e, !ate of =irth, 'rgentina
%o$#uterised 5ational Identity %ard 5u$ber (%5I%).
2. <o #rovide 0other*s 0aiden 5a$e

%&
$ustria ES
1. <o #rovide co$#lete 'ustria -esidential 'ddress, (ull 5a$e, !ate of =irth, 'ustria 5ational
Identity 5u$ber.

%&
(angladesh

ES
1. <o #rovide co$#lete =angladesh -esidential 'ddress with #eriod of stay, (ull 5a$e, !ate of
=irth.
2. <o #rovide (ather*s (ull 5a$e.

%&
(elgium
ES
1. <o #rovide co$#lete =elgiu$ -esidential 'ddress with #eriod of stay, (ull 5a$e, !ate of =irth.

%&


(ermuda
ES
1. <o #rovide co$#lete =er$uda -esidential 'ddress, (ull 5a$e, !ate of =irth.
2. <o #rovide 0other*s 0aiden 5a$e, (ather* (ull 5a$e.

%&
Canada ES
1. %o$#lete and return the &%anada %ri$inal %heck* for$
2. %anada 2ocial Insurance 5u$ber (2I5) 4 if any.
. %anada -esidential 'ddress with )ostal %ode.
9. %o#ies of 2 govern$ent issued Identity docu$ents. %o$#lete list8
)ass#ort (%anadian or foreign)
!rivers licence (%anadian or foreign)
)er$anent -esident card
%anadian %iti"enshi# card
%ertificate of Indian 2tatus
International 2tudent Identity %ard
(irear$s 'c7uisition %ertificate
%anadian 5ational Institute of the =lind (%5I=) Identification
%ard
(ederal,)rovincial,0unici#al Identification %ard 4 2o$e
#rovinces issue a #hoto I! card through the 0inistry of
<rans#ortation (!river*s 6icence >ffices) for those #ersons who
do not have a driver*s licence and have a need for an I! card.
>ther #rovincial $inistries also issue I! cards to show #roof of
age re7uired to #urchase li7uor. <his for$ of I! is also known
as an +'ge of 0a?ority. card.

<he following $ay be used as secondary for$s of I! if a second for$ of
govern$ent issued #hoto I! is not available.
Hunting 6icence
(ishing 6icence
=oating 6icence
6%=> (=@I!) card
2tudent card
=irth certificate

%&

%anada 2ocial Insurance
5u$ber (%2I5)
China ES
1. %o$#lete and return the &%hina %ri$inal %heck ; )-% 131 -ecord %heck* for$. 'll details $ust
be in :nglish A %hinese.
2. (or %hinese %iti"en, to #rovide full na$e in %hinese %haracter, )-% 5ational Identity 5u$ber,
)-% Hukou address are $andatory re7uire$ents.
. (or foreigners, to #rovide a co#y of #ass#ort.

%&
)enmark ES
1. <o #rovide co$#lete !en$ark -esidential 'ddress, (ull 5a$e, !ate of =irth, !en$ark 5ational
Identity 5u$ber.

%&


*ermany

ES
1. <o #rovide co$#lete 1er$any -esidential 'ddress, (ull 5a$e, !ate of =irth.

%&
+onduras ES
1. <o #rovide co$#lete Honduras -esidential 'ddress with #eriod os stay, (ull 5a$e, !ate of =irth.
2. <o #rovide 0other*s 0aiden 5a$e, (ather* (ull 5a$e.

%&

+ong ,ong ES
1. )rovide your Hong Bong Identification nu$ber in the s#ace #rovided
(right)
2. %o$#lete Hong Bong -esidential 'ddress, (ull 5a$e, !ate of =irth.
. If <ertiary education is obtained at8
>#en Cniversity #lease co$#lete the &>#en Cniversity 6etter of
'uthorisation* for$ '5! , >-
%hinese Cniversity #lease co$#lete the &Cniversity 6etter of
'uthorisation* for$
%&

HBI! 5u$ber8

India ES
1. %andidates (ull 5a$e
2. !ate of =irth
. (ather*s co$#lete na$e
9. (ull address,s in India and #eriod of stay

%&
Indonesia ES
1. (or Indonesia %iti"en, to #rovide (ull 5a$e, 5ational Identity
5u$ber (B<)), )ass#ort 5u$ber, !ate of =irth, %o$#lete Indonesia
-esidential 'ddress.
2. (or foreigners, to #rovide a co#y of #ass#ort, %o$#lete Indonesia

%&
Indonesian Identity 5unber
(B<))8

Ireland ES
1. %o$#lete Ireland -esidential 'ddress.
2. %andidateDs full na$e (including any aliases,$aiden na$es) and !ate of =irth.
. )revious 'ddresses in Ireland (if any).

%&


Italy YES
1. Full Name
2. Valid Letter of Authorization (FADV LOA)
3. Date of Birth
4. Italian odi!e Fi"!ale Italian #a$ Num%er
&. Addre"" in Ital'

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

N
No information re(uired
!apan YES
1. om)lete and return *+a)an Letter of Authori"ation form,. All
information mu"t %e in -n.li"h and +a)ane"e
2. #o )ro/ide om)lete +a)an 0e"idential Addre"" and Full Name (in
%oth -n.li"h and 1an2i)3 Date of Birth.
3. +a)an 4a"")ort Num%er (if a/aila%le).
4. Name in "#an$i% or "#atakana%

N
Full Name (in 1an2i or
1ata5ana and -n.li"h)6

Date of Birth (in 1an2i or

Addre"" in +a)an (in 1an2i or

4a"")ort Num%er6

#orea YES
1. om)lete and return the 1orea redit on"ent Form
2. 1orean National Identit' Num%er.
3. om)lete 1orea 0e"idential Addre""3 Full Name3 Date of Birth.

N
1orean Identifi!ation Nun%er6

&alaysia YES
1. For 7ala'"ia itizen3 to )ro/ide 7ala'"ia National Identit' Num%er
(Both Old and Ne8)3 Full Name3 Date of Birth3 !om)lete 7ala'"ia
addre"".
Note 9 7ala'"ian %orn %efore 'ear 1:;; 8ill need to )ro/ide Old National
Identit' Num%er.
2. For forei.ner"3 to )ro/ide a !o)' of 4a"")ort.

N
7ala'"ian Identit' ard No6
Mauritius YES
1. #o )ro/ide !om)lete 7auritiu" 0e"idential Addre"" 8ith )eriod
of "ta'3 Full Name3 Date of Birth

N


%etherlands ES
1. <o #rovide co$#lete 5etherlands -esidential 'ddress with #eriod of
stay, (ull 5a$e, !ate of =irth, 5etherlands 5ational Identify
5u$ber.

%&

%e3 4ealand ES
1. %o$#lete and return the 5ew Iealand %ri$inal %heck (or$ ie.
0inistry of /ustice (0>/) A 5I ('!E (or$.
2. )hoto and signature #ages of )ass#ort or !riving 6icense co#y.

%&-E8 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 Identit
form on page ! section " of the #$% form, signed b a witness.

%&

%epal ES
1. (or 5e#al %iti"en, to #rovide co$#lete 5e#al -esidential 'ddress
with #eriod of stay, (ull 5a$e, !ate of =irth, (ather*s (ull 5a$e.
2. (or (oreigners, to #rovide a co#y of #ass#ort, co$#lete 5e#al

%&

Pakistan ES
1. <o #rovide co$#lete )akistan -esidential 'ddress (#revious Acurrent)
2. )eriod of 2tay at each address
. (ull 5a$e
9. !ate of =irth
5. (athers full na$e
J. )akistan %o$#uterised 5ational Identity %ard 5u$ber (%5I%).
H. ' co#y of <ranscri#t of -ecord and !egree %ertificate (a##licable to
cases with acade$ic checks).

%&
)akistan residential address
(in full)8

)akistan 5ational I!
Panama ES
1. 2ub?ect*s (ull na$e
2. !>=
. 0otherDs 0aiden 5a$e
9. (atherDs co$#lete na$e
5. (ull 'ddress in )ana$a with )ostal code
J. )ass#ort K or International I!
H. 2igned general release (or$


%&

Peru ES
1. <o #rovide co$#lete )eru -esidential 'ddress, (ull 5a$e, !ate of
=irth.
2. <o #rovide 0other*s 0aiden 5a$e.

%&

Philippines ES
1. <o #rovide co$#lete )hili##ines -esidential 'ddress, (ull 5a$e, !ate
of =irth.
2. <o sub$it >riginal 5=I %ertificate.
. ' co#y of !egree %ertificate or <ranscri#t of -ecord (a##licable to
cases with acade$ic checks).

%&

Singapore
ES
1. (or 2inga#ore %iti"en, to #rovide 5ational Identity 5u$ber.
2. (or (oreigners, to #rovide (oreign Identification 5u$ber ((I5), co#y
of #ass#ort.
%&
2inga#ore 5-I% or (I5
5unber8

Sri 5anka ES
1. (ull 5a$e
2. !ate of =irth
. <o #rovide co$#lete 2ri 6anka -esidential 'ddress with #eriod of stay

%&
South $frica ES
1. (ull 5a$e
2. !ate of =irth
. %o$#lete 2outh 'frica address along with #eriod of stay
9. ' clear scanned co#y of 2outh 'frican I! (for 2outh 'frica citi"en)
5. ' clear scanned co#y of )ass#ort (for non 2outh 'frica citi"en)

%&

Spain ES
1. <o #rovide co$#lete 2#ain -esidential 'ddress, (ull 5a$e, !ate of
=irth, 2#ain 5ational Identity 5u$ber.

%&


S3eden ES
1. <o #rovide co$#lete 2weden -esidential 'ddress, (ull 5a$e, !ate
of =irth, 2weden 5ational Identity 5u$ber.

%&

S3it6erland ES
1. <o #rovide co$#lete 2wit"erland -esidential 'ddress with #eriod of
stay, (ull 5a$e, !ate of =irth, 0artial 2tatus.
2. <o #rovide (ull 5a$e of #arents.
. <o #rovide 0other*s full $aiden na$e.
9. <o #rovide a co#y of #ass#ort or 5ational Identity %ard.

5><: 8 &pon receipt of P'S re(uest, )sia P'S shall appl for a personali*ed
computer generated Swit*erland +riminal +onsent ,orm from the local
authorit. -he form will then be provided to the candidate to sign and
return to )sia P'S for the chec. to commence.

%&

-ai3an ES
1. (or <aiwan %iti"en, to #rovide (ull 5a$e (:nglish and %hinese
%haracters), <aiwan 5ational Identity 5u$ber, !ate of =irth.
2. (or (oreigners, to #rovide a co#y of #ass#ort, co$#lete <aiwan

%&
<aiwan Identity 5u$ber8

5a$e in %hinese characters8

-hailand ES
1. (or <hailand %iti"en, to #rovide a co#y of <hailand 5ational Identity
%ard.
2. (or (oreigners, to #rovide a co#y of #ass#ort, co$#lete <hailand

%&
<hai )ass#ort 5o8

5a$e in <hai %haracters8

7nited
,ingdom
ES
1. <o #rovide co$#lete CB -esidential 'ddress, (ull 5a$e, !ate of
=irth.

%&
CB residential address (in
full)8

7S$ ES
1. <o #rovide co$#lete C2 -esidential 'ddress, (ull 5a$e, !ate of
=irth.
2. <o #rovide C2 225 (if any).

%&
2ocial 2ecurity 5u$ber8

C2 residential address (in
full)8

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



/ /

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



/ /



/ /



/ /



/ /



/ /

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.

Applicants 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).

PRIVACYSTATEMENT
Ourcommitment
FirstAdvantageAustraliaPtyLtdACN101863209&FirstAdvantageNewZealandLimited("FirstAdvantage",
"we","us"or"our")arebackgroundscreeningserviceproviders.
Wehavebeenengagedbyyourprospectiveorcurrentemployer,contractorofyourservices,orlandlord(the
Requestor)toconductbackgroundchecksandtoverifytheinformationyouhaveormayprovideinapplyingfor
employment/engagementorhousingwiththeRequestor.
Someofthisinformationmaybe"personalinformation"forthepurposesoftheAustraliaandNewZealandPrivacy
Acts:PrivacyAct1988(Cth)(theAct)&PrivacyAct1993No.28(Act)."Personalinformation"isdefined(i)under
theAustraliaPrivacyAct,as"informationoranopinion(includinginformationoranopinionformingpartofa
database),whethertrueornot,andwhetherrecordedinamaterialformornot,aboutanindividualwhose
identityisapparent,orcanreasonablybeascertained,fromtheinformationoropinion",and(ii)undertheNew
ZealandPrivacyAct,asInformationaboutanidentifiableindividual;andincludesinformationrelatingtoadeath
thatismaintainedbytheRegistrarGeneralpursuanttotheBirths,Deaths,Marriages,andRelationship
RegistrationAct1995,oranyformerAct.
Werecognisetheimportanceofprivacyissuesandrespecttheconfidentialityofthepersonalinformationyou
providetous.WewilldealwithyourpersonalinformationinaccordancewiththeAustraliaPrivacyAct,the
NationalPrivacyPrinciples(NPPs)andNewZealandPrivacyAct,InformationPrivacyPrinciples(IPPs)established
bytheAct(s),ourPrivacyPolicyandPrivacyStatement(bothasamendedfromtimetotime).
ThisPrivacyStatementistobereadinconjunctionwithourPrivacyPolicy.Shouldtherebeanydifferencebetween
them,theprovisionsofthePrivacyStatementwillprevail.
PurposeofcollectingInformation
Inthisform,youhavebeenaskedbytheRequestortoprovideinformationregardingyourbackgroundand/orthe
employment/engagementrequestyoumadetotheRequestor.
Dependingonthepositionofemployment/engagementyouareapplyingfororyournewroleinyourorganisation,
theRequestormayberequiredbylawtodetermineyoursuitabilityfortheposition,forexampleunderthe
CorporationsAct2001(Cth)and/ortheAntiMoneyLaunderingandCounterTerrorismFinancingAct2006(Cth)
andAntiMoneyLaunderingandCounteringFinancingofTerrorismAct2009.
TheRequestorhasengagedFirstAdvantagetoverifytheinformationandresponsesyouprovidedbyarrangingfor
ustocarryoutverificationchecksinordertoassisttheRequestortodetermineyoursuitabilityfor(i)
employment/engagementpursuanttotheirlegalobligationsand/orinternalriskmanagementpolicyor(ii)rental
ofadwellingpursuanttotheirinternalriskmanagementpolicy.
Inordertoprocessandverifyyourapplication,theRequestorandFirstAdvantagemaycollectyourpersonal
information(includingbutnotlimitedtoinformationrelatingtoyourbackground,characterandpersonal
reputation)and,ifnecessary,usesomeorallofthecollectedpersonalinformationtocollectadditionalpersonal
informationfromvariousotherentities(theSources).ExamplesofSourcesinclude,butarenotlimitedto,
governmentagencies,lawenforcementbodies,publiclyavailablerecords,publicregistries,courtortribunal
records,ratingsagencies,educationalinstitutions,andregulatoryandlicensingbodies.FirstAdvantagemayreport
thefindingsofitsinvestigationstotheRequestorviaasecuremeans.
WemayalsocollectotherPersonalInformationwhichissensitiveinformation(e.g.criminalrecords)forthesame
purpose.AnysensitiveinformationwecollectwillbecarriedoutinaccordancewiththeNPPs.Wemay,fromtime
totime,needtocollectinformationaboutyoufromathirdpartyyourefertous.Whenweobtainpersonaland
otherinformationfromthirdpartiestowhomwearereferredbyyou,wewillassumethatyouhavereferredFirst
Advantagetothemandinformedthemofthepurposesinvolvedinthecollection,useanddisclosureofthe
relevantpersonalorotherinformation.
Ifyoudonotconsenttoprovidethepersonalinformationrequested,wemaynotbeabletoverifydetailsforyour
employment/engagementapplicationandtheRequestormaynotbeabletoproceedwiththeapplicationprocess.
Useanddisclosureofyourinformation
Wemayuseanddisclosetheinformationanddocumentationandanyresponsesyouhaveprovidedtoapplytothe
Sourcesforverificationofthepersonalandotherinformationyouorathirdpartyhasprovided,andtoconduct
publicrecordsearches.
DependingonthebackgroundchecksrequiredbytheRequestorandinformationyousupplyinthisform,wemay
alsoconductbackgroundchecksonyouremployment/engagementhistoryandreferences(withtheexceptionof
yourcurrentemployer/engager,unlessyouhaveauthorisedsuchcontactorcommenceemployment/engagement
withtheRequestor),education,professionalqualifications,residency,sanctions,immigrationstatus,criminal
records,claims,judgments,currentandpreviousdirectorships,character,personalreputation,andconductsuch
otherchecksandenquiriesastheRequestorconsidersnecessarytoverifyinformationprovidedbyyouinyour
employment/engagementapplicationorrentalapplication.
ThepersonalinformationyouprovideandanyotherpersonalinformationprovidedbytheSourcesasaresultof
theverificationprocesswillbeprocessedandprovidedbyustotheRequestor,whomaythenusethisinformation
toconsideryoursuitabilityforemployment/engagementorthechangeinlevelofresponsibility,orrentalofa
dwelling,ortodetermineiffurtherverificationorinvestigationisnecessary.Ifyouarecurrentlyorsubsequently
employed/engaged,thisinformationmaybecomepartofyouremployment/engagementrecords.
Intheeventthatyouareofferedemployment/engagementwiththeRequestor,wemayberequestedtoobtainan
employment/engagementreportorinvestigativereportinconnectionwithsubsequentemployment/engagement
decisions.
Wemay,fromtimetotime,needtoretainpersonalinformationcollectedfromyouandtheSourcestocomply
withourcontractual,statutoryorotherlegalobligationsevenaftertheemployment/engagementapplication
processortherentalapplicationprocessiscompletedorterminated.
OverseasTransfersofPersonalInformation
Wewillonlytransferpersonalinformationoverseasif:
wereasonablybelievethattherecipientoftheinformationissubjecttoalaworacontractthateffectively
upholdsprivacyprinciplessimilartotheNPP'sand/orIPPs;
youhaveconsentedtothetransfer;
thetransferisnecessaryforustoprovidetheClientwiththeirrequestedservice;
itisnotpracticaltoobtainyourconsent,thetransferisforyourbenefitandyourconsentwouldlikelybegiven;
or
wehavetakenreasonablestepstoensurethatyourpersonalinformationwillnotbeheld,usedordisclosedby
therecipientinamannerinconsistentwiththisPrivacyPolicyandtheNPP'sand/orIPPs.
Accessandcorrectionofinformation
Ifyouwishtoobtainaccesstoyourpersonalinformationwhichisheldbyus,youmayapplyforaccessby
contactingthePrivacyOfficeratthecontactdetailssetoutinthisPrivacyStatement.Certainadditionaltermsand
conditionsmaybeapplicabletoprovideyouwithaccesstoyourpersonaldata,likerequiringproperproofof
identificationlikeagovernmentpictureID,priortoprovidingyouaccesswithyourpersonalinformation.
WewillhandlerequestsforaccesstoyourpersonalinformationinaccordancewiththeNPPs.However,insome
circumstancespermittedundertheNPPs,wemaynotberequiredtogiveyouaccesstotheinformationwehold
aboutyou.
Itisimportanttousthatthepersonalinformationweholdaboutyouisaccurate,completeanduptodate.Ifyou
areawarethatthisisnotthecaseandwouldliketocorrectyourPersonalInformation,youmaylodgeacorrection
requestbycontactingthePrivacyOfficeratthecontactdetailslistedinthisPrivacyStatement.Pleasenotethatthe
PrivacyOfficerlistedbelowhandlesrequestsfromAustraliaandNewZealand.FirstAdvantagewillmakeall
reasonableeffortstocorrecttheinformation.However,ifapplicable,wewillalsodirectyoutothesourceofthe
informationforcorrection.
AnycomplaintsaboutabreachofprivacywillbedealtwithinaccordancewithourPrivacyPolicy.Ifyouhavea
complaintaboutthewayFirstAdvantagehasdealtwithyourpersonalinformation,oryouwouldlikeacopyofthe
PrivacyPolicy,pleasecontactourPrivacyOfficerat:
ThePrivacyOfficer
FirstAdvantage
POBox455
NorthSydneyNSW2059
Tel:+61290174300
DetailsofourPrivacyPolicyarealsoavailableatwww.FADV.com/au.Ifyouareunsatisfiedwiththeoutcome,you
mayreferthemattertothePrivacyCommissionerat:
AustralianResidents:
Website:www.privacy.gov.au
Tel:1300363992
NewZealandResidents:
Email:enquiries@privacy.org.nz
Tel:044747590
CONSENTTOCOLLECTION,USEANDSTORAGEOFINFORMATION
Declaration:I.......................................................................................................................................................,
(Enteryourfull,legalname,asperyouridentificationdocumentinBLOCKletters)
authorisetheRequestor,FirstAdvantage,andanyofits/theirrelatedentitiesandaffiliates,andanypersonsor
organisationsactingonits/theirbehalftotakestepstoverifytheinformationanddocumentationpresentedinmy
application.
IacknowledgeandagreethatthisprocessinvolvestheRequestor,FirstAdvantage,andanyofits/theirrelated
entitiesandaffiliates,andanypersonsororganisationsactingonits/theirbehalfcollecting,usingand/or
disclosing,andretainingmypersonalinformationinthemannerdescribedinthePrivacyStatementabove.Ialso
acknowledgeandagreethatFirstAdvantagewillbeusingsomeofitsrelatedentitiesandaffiliatestoprocessthis
requestandthatmypersonalinformationwillbeprovidedtotheminordertocarryoutmybackgroundsearch.
IherebyreleasefromliabilityFirstAdvantage,itsrelatedentitiesandaffiliatesandtheirrespectiveemployees
requestingorsupplyingsuchinformation,ifdonesoinaccordancewiththeFirstAdvantagePrivacyStatementand
Policyandapplicablelaws.Iunderstandthatmyemployment/engagementwiththeRequestormaybeterminated
withimmediateeffectshouldanyinformationprovidedhereinbeprovenuntrue.
IalsoagreethatallinformationanddocumentsprovidedtotheRequestorandFirstAdvantageinmyapplication,
canbeusedtocarryouttherequiredbackgroundcheck,includingidentificationdocumentssupplied.
IalsoconsenttoFirstAdvantageretainingPersonalInformationcollectedfrommeandtheSourcestocomplywith
theircontractual,statutoryorotherlegalobligations,evenaftertheemployment/engagementapplicationprocess
iscompletedorterminated.
(Candidate)PleaseSign:_____________________________________________
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
rsum/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:
|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|

|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|

Social Insurance Number |__|__|__|__|__|__|__|__|__| Birth Date: |__|__| |__|__| |__|__|__|__|
(Optional) (Required for Criminal Check) DD MM YYYY

Drivers License Number and Province of Issue |__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|
(Required for driver record search)

Applicants Signature: ______________________________ Todays 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________________________________________ Todays 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
Peoples Republic of China
Personal Details Sheet for Screening Purposes for PRC citizens

( (( ( ) )) )

Please complete all requested details in Chinese.
Name in Chinese
and Former Name (if applicable)
()

PRC Identity Number and DOB
()
. (Identity No) :
(Date of Birth: yy-mm-dd) :
Hukou Address, Name of Police
Office and Hukou Type
(
)
(Hukou Address)

(Name of Police Office)
(Hukou Type)
(Group Name)
(Individual)
Entity that holds the official
personal record file, Contact
information & File No.
(
)
(Entity Name)
(Tel no)
(Personal File is kept by yourself, File No)

(Personal file is kept by your employer,
Employers Name)
Can a reference be taken now?
()?
If no, when can it be taken?
()?
Yes () No ()
For Students and Graduates
whose personal record file are
kept at the university only
(
)
(Name of Institution)
(Major/Area of Specialization)
(Class Last Attended, Student No)
(Qualification obtained)

Signed in Chinese

______________

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 Bearers 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 companys 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)

23 1 29 3
25 1

/ /
/ /

/ /
/ /
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 Thir d Party
Third Party Name Details
Suburb
City
State / Province
Post Code
Country
Page 1 of 3 Form continues overleaf
X
Signature of subject 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 appl icable)
Third Party Address Details
X
Signature of Thi rd 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 appl icable)
Insurance Claims vetting
All convictions report Traffic Convictions Report
Tick the report required:
Street Address
P.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 Address
P.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 this section
The person who identifies subject 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 per sonally 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
PRIVACYSTATEMENT
Ourcommitment
FirstAdvantageAustraliaPtyLtdACN101863209&FirstAdvantageNewZealandLimited("FirstAdvantage",
"we","us"or"our")arebackgroundscreeningserviceproviders.
Wehavebeenengagedbyyourprospectiveorcurrentemployer,contractorofyourservices,orlandlord(the
Requestor)toconductbackgroundchecksandtoverifytheinformationyouhaveormayprovideinapplyingfor
employment/engagementorhousingwiththeRequestor.
Someofthisinformationmaybe"personalinformation"forthepurposesoftheAustraliaandNewZealandPrivacy
Acts:PrivacyAct1988(Cth)(theAct)&PrivacyAct1993No.28(Act)."Personalinformation"isdefined(i)under
theAustraliaPrivacyAct,as"informationoranopinion(includinginformationoranopinionformingpartofa
database),whethertrueornot,andwhetherrecordedinamaterialformornot,aboutanindividualwhose
identityisapparent,orcanreasonablybeascertained,fromtheinformationoropinion",and(ii)undertheNew
ZealandPrivacyAct,asInformationaboutanidentifiableindividual;andincludesinformationrelatingtoadeath
thatismaintainedbytheRegistrarGeneralpursuanttotheBirths,Deaths,Marriages,andRelationship
RegistrationAct1995,oranyformerAct.
Werecognisetheimportanceofprivacyissuesandrespecttheconfidentialityofthepersonalinformationyou
providetous.WewilldealwithyourpersonalinformationinaccordancewiththeAustraliaPrivacyAct,the
NationalPrivacyPrinciples(NPPs)andNewZealandPrivacyAct,InformationPrivacyPrinciples(IPPs)established
bytheAct(s),ourPrivacyPolicyandPrivacyStatement(bothasamendedfromtimetotime).
ThisPrivacyStatementistobereadinconjunctionwithourPrivacyPolicy.Shouldtherebeanydifferencebetween
them,theprovisionsofthePrivacyStatementwillprevail.
PurposeofcollectingInformation
Inthisform,youhavebeenaskedbytheRequestortoprovideinformationregardingyourbackgroundand/orthe
employment/engagementrequestyoumadetotheRequestor.
Dependingonthepositionofemployment/engagementyouareapplyingfororyournewroleinyourorganisation,
theRequestormayberequiredbylawtodetermineyoursuitabilityfortheposition,forexampleunderthe
CorporationsAct2001(Cth)and/ortheAntiMoneyLaunderingandCounterTerrorismFinancingAct2006(Cth)
andAntiMoneyLaunderingandCounteringFinancingofTerrorismAct2009.
TheRequestorhasengagedFirstAdvantagetoverifytheinformationandresponsesyouprovidedbyarrangingfor
ustocarryoutverificationchecksinordertoassisttheRequestortodetermineyoursuitabilityfor(i)
employment/engagementpursuanttotheirlegalobligationsand/orinternalriskmanagementpolicyor(ii)rental
ofadwellingpursuanttotheirinternalriskmanagementpolicy.
Inordertoprocessandverifyyourapplication,theRequestorandFirstAdvantagemaycollectyourpersonal
information(includingbutnotlimitedtoinformationrelatingtoyourbackground,characterandpersonal
reputation)and,ifnecessary,usesomeorallofthecollectedpersonalinformationtocollectadditionalpersonal
informationfromvariousotherentities(theSources).ExamplesofSourcesinclude,butarenotlimitedto,
governmentagencies,lawenforcementbodies,publiclyavailablerecords,publicregistries,courtortribunal
records,ratingsagencies,educationalinstitutions,andregulatoryandlicensingbodies.FirstAdvantagemayreport
thefindingsofitsinvestigationstotheRequestorviaasecuremeans.
WemayalsocollectotherPersonalInformationwhichissensitiveinformation(e.g.criminalrecords)forthesame
purpose.AnysensitiveinformationwecollectwillbecarriedoutinaccordancewiththeNPPs.Wemay,fromtime
totime,needtocollectinformationaboutyoufromathirdpartyyourefertous.Whenweobtainpersonaland
otherinformationfromthirdpartiestowhomwearereferredbyyou,wewillassumethatyouhavereferredFirst
Advantagetothemandinformedthemofthepurposesinvolvedinthecollection,useanddisclosureofthe
relevantpersonalorotherinformation.
Ifyoudonotconsenttoprovidethepersonalinformationrequested,wemaynotbeabletoverifydetailsforyour
employment/engagementapplicationandtheRequestormaynotbeabletoproceedwiththeapplicationprocess.
Useanddisclosureofyourinformation
Wemayuseanddisclosetheinformationanddocumentationandanyresponsesyouhaveprovidedtoapplytothe
Sourcesforverificationofthepersonalandotherinformationyouorathirdpartyhasprovided,andtoconduct
publicrecordsearches.
DependingonthebackgroundchecksrequiredbytheRequestorandinformationyousupplyinthisform,wemay
alsoconductbackgroundchecksonyouremployment/engagementhistoryandreferences(withtheexceptionof
yourcurrentemployer/engager,unlessyouhaveauthorisedsuchcontactorcommenceemployment/engagement
withtheRequestor),education,professionalqualifications,residency,sanctions,immigrationstatus,criminal
records,claims,judgments,currentandpreviousdirectorships,character,personalreputation,andconductsuch
otherchecksandenquiriesastheRequestorconsidersnecessarytoverifyinformationprovidedbyyouinyour
employment/engagementapplicationorrentalapplication.
ThepersonalinformationyouprovideandanyotherpersonalinformationprovidedbytheSourcesasaresultof
theverificationprocesswillbeprocessedandprovidedbyustotheRequestor,whomaythenusethisinformation
toconsideryoursuitabilityforemployment/engagementorthechangeinlevelofresponsibility,orrentalofa
dwelling,ortodetermineiffurtherverificationorinvestigationisnecessary.Ifyouarecurrentlyorsubsequently
employed/engaged,thisinformationmaybecomepartofyouremployment/engagementrecords.
Intheeventthatyouareofferedemployment/engagementwiththeRequestor,wemayberequestedtoobtainan
employment/engagementreportorinvestigativereportinconnectionwithsubsequentemployment/engagement
decisions.
Wemay,fromtimetotime,needtoretainpersonalinformationcollectedfromyouandtheSourcestocomply
withourcontractual,statutoryorotherlegalobligationsevenaftertheemployment/engagementapplication
processortherentalapplicationprocessiscompletedorterminated.
OverseasTransfersofPersonalInformation
Wewillonlytransferpersonalinformationoverseasif:
wereasonablybelievethattherecipientoftheinformationissubjecttoalaworacontractthateffectively
upholdsprivacyprinciplessimilartotheNPP'sand/orIPPs;
youhaveconsentedtothetransfer;
thetransferisnecessaryforustoprovidetheClientwiththeirrequestedservice;
itisnotpracticaltoobtainyourconsent,thetransferisforyourbenefitandyourconsentwouldlikelybegiven;
or
wehavetakenreasonablestepstoensurethatyourpersonalinformationwillnotbeheld,usedordisclosedby
therecipientinamannerinconsistentwiththisPrivacyPolicyandtheNPP'sand/orIPPs.
Accessandcorrectionofinformation
Ifyouwishtoobtainaccesstoyourpersonalinformationwhichisheldbyus,youmayapplyforaccessby
contactingthePrivacyOfficeratthecontactdetailssetoutinthisPrivacyStatement.Certainadditionaltermsand
conditionsmaybeapplicabletoprovideyouwithaccesstoyourpersonaldata,likerequiringproperproofof
identificationlikeagovernmentpictureID,priortoprovidingyouaccesswithyourpersonalinformation.
WewillhandlerequestsforaccesstoyourpersonalinformationinaccordancewiththeNPPs.However,insome
circumstancespermittedundertheNPPs,wemaynotberequiredtogiveyouaccesstotheinformationwehold
aboutyou.
Itisimportanttousthatthepersonalinformationweholdaboutyouisaccurate,completeanduptodate.Ifyou
areawarethatthisisnotthecaseandwouldliketocorrectyourPersonalInformation,youmaylodgeacorrection
requestbycontactingthePrivacyOfficeratthecontactdetailslistedinthisPrivacyStatement.Pleasenotethatthe
PrivacyOfficerlistedbelowhandlesrequestsfromAustraliaandNewZealand.FirstAdvantagewillmakeall
reasonableeffortstocorrecttheinformation.However,ifapplicable,wewillalsodirectyoutothesourceofthe
informationforcorrection.
AnycomplaintsaboutabreachofprivacywillbedealtwithinaccordancewithourPrivacyPolicy.Ifyouhavea
complaintaboutthewayFirstAdvantagehasdealtwithyourpersonalinformation,oryouwouldlikeacopyofthe
PrivacyPolicy,pleasecontactourPrivacyOfficerat:
ThePrivacyOfficer
FirstAdvantage
POBox455
NorthSydneyNSW2059
Tel:+61290174300
DetailsofourPrivacyPolicyarealsoavailableatwww.FADV.com/au.Ifyouareunsatisfiedwiththeoutcome,you
mayreferthemattertothePrivacyCommissionerat:
AustralianResidents:
Website:www.privacy.gov.au
Tel:1300363992
NewZealandResidents:
Email:enquiries@privacy.org.nz
Tel:044747590
CONSENTTOCOLLECTION,USEANDSTORAGEOFINFORMATION
Declaration:I.......................................................................................................................................................,
(Enteryourfull,legalname,asperyouridentificationdocumentinBLOCKletters)
authorisetheRequestor,FirstAdvantage,andanyofits/theirrelatedentitiesandaffiliates,andanypersonsor
organisationsactingonits/theirbehalftotakestepstoverifytheinformationanddocumentationpresentedinmy
application.
IacknowledgeandagreethatthisprocessinvolvestheRequestor,FirstAdvantage,andanyofits/theirrelated
entitiesandaffiliates,andanypersonsororganisationsactingonits/theirbehalfcollecting,usingand/or
disclosing,andretainingmypersonalinformationinthemannerdescribedinthePrivacyStatementabove.Ialso
acknowledgeandagreethatFirstAdvantagewillbeusingsomeofitsrelatedentitiesandaffiliatestoprocessthis
requestandthatmypersonalinformationwillbeprovidedtotheminordertocarryoutmybackgroundsearch.
IherebyreleasefromliabilityFirstAdvantage,itsrelatedentitiesandaffiliatesandtheirrespectiveemployees
requestingorsupplyingsuchinformation,ifdonesoinaccordancewiththeFirstAdvantagePrivacyStatementand
Policyandapplicablelaws.Iunderstandthatmyemployment/engagementwiththeRequestormaybeterminated
withimmediateeffectshouldanyinformationprovidedhereinbeprovenuntrue.
IalsoagreethatallinformationanddocumentsprovidedtotheRequestorandFirstAdvantageinmyapplication,
canbeusedtocarryouttherequiredbackgroundcheck,includingidentificationdocumentssupplied.
IalsoconsenttoFirstAdvantageretainingPersonalInformationcollectedfrommeandtheSourcestocomplywith
theircontractual,statutoryorotherlegalobligations,evenaftertheemployment/engagementapplicationprocess
iscompletedorterminated.
(Candidate)PleaseSign:_____________________________________________
Date:______________________________(DD/MM/YYYY)
Page 1 / 11
Strictly Private and Confidential
(when completed)

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*/SF ^SS + ^ [/ FIRST ADVANTAGE7 Z /^ =/ P
Ij [/ ,9 PII.

Z= Z= Z= Z=:
+9/ /^ j =/9 ( ), +I{, /{3, {7, i, =^ P
} / j =J, , {, =+, 7 P J=9 I ^ji {9 )[
^ /9/P /, /, , ^, ^/, ^, * + ^= }/P , ^^, */,
/{3, +I3 P 7 j I ,9 PII.

[[ [ [ [/=9 /=9 /=9 /=9 =*M =*M =*M =*M 5 5 5 5* * * *7 77 7 9 9 9 9 ^ ^ ^ ^]
, FIRST ADVANTAGE7 5^ 5^ 5^ 5^ } } } } ^P ^P ^P ^P S0 S0 S0 S0 = = = = 5 5 5 5 P 7 5
+= \= {j + lII. 5* P/ }9 / SF 27) I9 '
j II.

ZI} ZI} ZI} ZI}:
[}} /{[/=^j +^ P 7 57 FIRST ADVANTAGE P ~= / j 7
, EMPLOYEE VETTING /^9 Z Z j { ^9 7j \j PII.
7, , y ^ + I9/ P E 5 */ M FIRST ADVANTAGEj
I9 Z= 7P^SS +I, ~=*/ ~ ', P 7 57 == {j \j
=II. E ^ * / M /{ * = 9 ^ ^ ^j
~II.

[FIRST ADVANTAGE 5P 57 ~=S 7j , ~ ~= / j 7 P iZ=79
I~ 7 {9 579 /{ I, 9 I~ /, , = P ^SS /{ P
EII.]

Z{ Z{ Z{ Z{:
FIRST ADVANTAGE 7 7553 Z179 P7^ *j ^I, Z17 2P =,
75 Z 7, 75 =^, 75 =, 5 5 j {9 I / Z18 3
Z219 P7 75P 5 + M V9 I~ , *[/ E ' *
P/ j VI, jP V E j ', 5 59 I~ ~\ II.

P P P P 7 7 7 7 {P {P {P {P :
P 7 {7 \I / j P 79 F @=([/ @7 j S 7=P
@) \I ,j II. ^ /^, =/ ^ 7 }9 7,
I / \j , 7} E l 7I IF, */ (9 F [7~,
{/^P 77 ^ ~ j PII. P 75 += j Z ^ First
Advantage9 P ^ ^j ;II.

+ ++ + 75P 75P 75P 75P Z9 Z9 Z9 Z9 PII PII PII PII. P P P P II II II II.

<^j5 ^j5 ^j5 ^j5>
Z Z Z Z ^j5 ^j5 ^j5 ^j5:
P ^j5 =37 FIRST ADVANTAGE9 Z 59 I ]9
Page 3 / 8

(when completed)
PII.

^j5P ^j5P ^j5P ^j5P Z=^ Z=^ Z=^ Z=^:
*/P [/ I FIRST ADVANTAGE7 j ^j I =37
j^j ~ \SI, =3 Z I9 PII.

^j5P ^j5P ^j5P ^j5P ZI} ZI} ZI} ZI}:
[}} /{[/=^j +^ P =37 FIRST ADVANTAGE P ~= / j 7
, EMPLOYEE VETTING /^9 Z Z j { ^9 7j \j PII.
7, , y ^ + I9/ P E 5 */ M FIRST ADVANTAGEj
I9 Z= 7P^SS +I, ~=*/ ~ ', P 7 57 == {j \j
=II. E ^ * / M /{ * = 9 ^ ^ ^j
~II.

Z{ Z{ Z{ Z{:
*[/ E ' * P/ j VI, jP V E j ', 5 59
I~ ~\ II.

P P P P 7 7 7 7 {P {P {P {P :
=3 Z P 7 {7 \I / j P 79 F @=([/ @7 j
S 7=P @) \I ,j II.

+ ++ + ^j5P ^j5P ^j5P ^j5P Z9 Z9 Z9 Z9 PII PII PII PII. P P P P II II II II.

/{[/ ^ [ 7 5M ^, ~ {I9/ 7 7 7 7 5 5 5 5 ]{ ]{ ]{ ]{, [ [ [ [
5P 5P 5P 5P 5 5 5 5 E E E E , [ [ [ [ 5 5 5 5 ^Z ^Z ^Z ^Z, 7^ 7^ 7^ 7^ 7 7 7 7 5 5 5 5 / / / /, ^ ^ ^ ^ j jj j [P [P [P [P M MM M E E E E
\ \ \ \ ^ ^ ^ ^ { { { {7 \j II.

9 P/ ZII.

E * + ^=}/ P , ^^, */, /{3, +I3 Z I9 \^
5 ^=}/ P P )j /=II.

/ Name in Korean:

/ Name in English:

7)j 7)j 7)j 7)j 7 7 7 7/ { {{ { / if applicable Previous/Maiden Name:

=3 =3 =3 =3 / Korean ID Number:

/ / / / / Signature:

^F ^F ^F ^F i i i i Z Z Z Z = = = = * * * * ~ ~ ~ ~ 7 7 7 7 ~ ~ ~ ~ ' ' ' ' lII lII lII lII.
Page 4 / 8

(when completed)
* Z Z Z Z 10 {P {P {P {P 5| 5| 5| 5| 7 7 7 7 i i i i Z Z Z Z
(jE ' j 7. Z i7 @ = E)
* PERMANENT RESIDENTAL ADDRESSES OVER THE LAST TEN YEARS IN KOREA
(Please attach Household Registration Certificate if necessary)

7)[ i / Residential Addresses
7{ / Period of Residence
(YYYY/MM) ~ (YYYY/MM)
1.
2.
3.
4.
5.
6.
Page 5 / 8

(when completed)
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 collected/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).

Page 6 / 8

(when completed)
[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 recruiting 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 candidates 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.]

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

(when completed)
acquiring and submitting my personal information.


<Unique Identification Information>
Items of Unique Identification Information to be provided:
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.

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 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 the 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

(when completed)

Only those candidates whose pre-employment screening 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.

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