<참고자료 2> 보안업무규정 시행규칙 별지 제22호 서식(자기소개서)<개정 2020.3.17.>

(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

RESIDENTIAL

ADDRESS

IN KOREA

WORKPLACE

JOB/TITLE

TELEPHONE

NUMBERS

(Include Area Code)

OFFICE :                     MOBILE :

EDUCATION

SCHOOL

NAME

PERIOD

(MM/YY-MM/YY)

TYPE

OF

DEGREE

MAJOR

LOCATION

(City/Country)

210mm×297mm [백상지(80/㎡) 또는 중질지(80/㎡)]

(2nd page)

EMPLOYMENT

HISTORY

&

PARTICIPATION

IN CIVIC/POLITICAL ASSOCIATION

EMPLOYER/

VERIFIER NAME

PERIOD

(MM/YY-MM/YY)

JOB TITLE/

POSITION

LOCATION

(City/Country)

REWARD &

PUNISHMENT

(MM/YY)

FAMILY

INFORMATION

RELATION

NAME

Last/First/Middle

DATE OF BIRTH

FINAL

ACADEMIC

DEGREE

CAREER

ADDRESS

RELATIVES

&

ASSOCIATES

IN KOREA

RELATION

NAME

Last/First/Middle

CAREER

JOB TITLE/

POSITION

TELEPHONE

NUMBER

I declare that statements made in this form are true and correct, and agree if false information is knowingly or willingly provided on this form, I can be penalized in accordance with the relevant statute.

DATE :

SIGNATURE :

210mm×297mm [백상지(80/㎡) 또는 중질지(80/㎡)]

(3rd page)

Consent to the Collection and Use of Personal Information

The National Intelligence Service, Ministry of National Defense, and National Police Agency intend to collect and use personal information, sensitive information, and personally identifiable information of the applicant for the conduction of background check pursuant to Article 46 (Processing of Personally Identifiable Information) of the "Regulations on Security Work," and Article 15 (Collection and Use of Personal Information), Article 23 (Limitation to Processing of Sensitive Information), and Article 24 (Limitation to Processing of Personally Identifiable Information) of the "Personal Information Protection Act."

■ Collection and use of personal information

Items

Name, gender, photo, nationality, place of birth, alien registration number, date & place of entry to korea, residential address in korea, workplace, job/title, telephone numbers(including office, mobile), education(including school name, period, type of degree, major, location), employment history & participation in civic/political association(including employer/verifier name, period, job title/position, location, reward&punishment), family information(including relation, name, date of birth, final academic degree, career, address), relatives & associates in korea(including relation, name, career, job title/position, telephone number)

Purpose of

collection/use

Background check and verification

Retention/

use period

2 years

※ The above is the minimum information required to carry out background check and the applicant has the right to refuse the collection and use of personal information. However, in case of refusal, there may be restrictions in appointment (employment) and security clearance, as background check cannot be carried out pursuant to "Regulations on Security Work."

☞ I agree to the collection and use of personal information as described above.
I agree [  ]    I do not agree [  ]

■ Processing of sensitive information

Items

Participation in civic/political association

Purpose of

collection/use

Background check and verification

Retention/

use period

2 years

※ The above is the minimum information required to carry out background check and the applicant has the right to refuse the processing of sensitive information. However, in case of refusal, there may be restrictions in appointment (employment) and security clearance, as background check cannot be carried out pursuant to "Regulations on Security Work."

☞ I agree to the processing of sensitive information as described above.
I agree [  ]    I do not agree [  ]

■ Processing of personally identifiable information

Items

Alien registration number

Purpose of

collection/use

Background check and verification

Retention/

use period

2 years

※ A separate consent is not required under subparagraph 1 of Article 24-2 (1) of the "Personal Information Protection Act"     and Article 46 of the "Regulations on Security Work."

☞ I have read and understood that personally identifiable information will be processed as described above. [  ]

We comply with personal information protection regulations that personal information processors are required to follow under the "Personal Information Protection Act." We will protect the rights of the information provider in accordance with relevant laws, and the collected information will not be used for purposes other than reasons agreed to by the information provider.

mm dd, yyyy

Applicant (representative):                  (seal or signature)

Legal representative (if needed):             (seal or signature)        Contact information:

210mm×297mm [백상지(80/㎡) 또는 중질지(80/㎡)]

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