外国专家证申请表

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1、外国专家证申请表ForeignExpertCertificateApplicationForm专家类别：□经济技术类□教科文卫类WorkingField：EconomicandTechnologyCulturalandEducationDONOTWRITEINTHISSPACE37*37PHOTOGluephotohere请勿填写此处大1寸免冠照片请用胶水将照片附于此处姓（如护照所示）：SURNAME(AsinPassport)名（如护照所示）：FIRSTANDMIDDLENAME(AsinPassport)其它曾用姓

2、氏（外文）：OTHERSURNAMEUSED(Maiden,Religious,Professional,Aliases)其它名字（外文）：OTHERFIRSTANDMIDDLENAMESUSED出生年月日：国籍：护照号码：DATEOFBIRTH(yy-mm-dd)NATIONALITYPASSPORTNUMBER译名：性别:□男□女CHINESENAMESEXMALEFEMALE出生地（外文）：国家省（州）城市PLACEOFBIRTH(Country-State-/Province-City)国外住址：HOMEADD

3、RESSINCOUNTRYOFORIGIN最高学历：EDUCATIONBACKGROUND原聘用单位：LASTEMPLOYER已在华连续工作时间：年月日至年月日SUCCESSIVETIMEYOUWORKEDINCHINALASTTIME(yy-mm-ddtoyy-mm-dd)现聘用单位名称：CURRENTEMPLOYER现聘用单位地址：ADDRESSOFCURRENTEMPLOYER现拟聘职务：POSITIONWITHCURRENTEMPLOYER聘用期限：年月日至年月日TIMEOFEMPLOYMENT(yy-mm-d

4、dtoyy-mm-dd)在粤住址：3ADDRESSINGUANGDONG现聘用单位联系人姓名、电话、传真：NAME,TELEPHONEANDFAXNUMBEROFCONTACTPERSONINCURRENTEMPLOYER随行家属情况ACCOMPANYINGFAMILYMEMBER123姓名FULLNAME与申请人关系RELATIONSHIPTOTHEAPPLICANT国籍NATIONALITY护照号码PASSPORTNUMBER您是否由于犯有任何罪行为曾经被逮捕或被判有罪，即使后来得到了赦免或收回等其他类似措施？HA

5、VEYOUEVERBEENARRESTEDORCONVICTEDFORANYOFFENSEORCRIME,EVENTHOUGHSUBJECTOFAPARDON,AMNESTYOROTHERSIMILARLEGALACTION?□是/YES□否/NO您是否曾感染过对公共健康有影响的传染病或患过构成危险体制病变或精神病？HAVEYOUEVERBEENAFFLICTEDWITHACOMMUNICABLEDISEASEOFPUBLICHEALTHSIGNIFICANCEFORADANGEROUSPHYSICALORMENTAL

6、DISORDER?□是/YES□否/NO您是否曾违反中国法律，被中国政府递解处境？HAVEYOUEVERVIOLATEDTHELAWOFCHINAANDDEFORTEDFROMCHINA?□是/YES□否/NO本申请表上所做之回答均属试试切相近，所附材料真实、有效，若所提交的内容被发现不实或不详，本人愿意承担法律责任。THISISTOCERTIFYTHATALLTHEANSWERSTOTHISAPPLICATIONANDRELEVANTATTACHEMNTSTOITARETRUEANDCOMPLETED.IFTHEIN

7、FORMATIONISFOUNDTOBEUNTRUEORUNCOMPLETED,IAMAWARETHATINEEDTOUNDERTAKECORRESPMDINGLEGALRESPONSIBILITIES.证件代办人签名：日期：SIGNATUREOFAPPLICANTORAGENTDATE(yy-mm-dd)3申报单位（盖章）：SEALOFEMPLOYER3