外国人来华工作许可申请表

1、外国人来华工作许可申请表（样表）（来华工作 90 日以上）APPLICATION FORM FOR FOREIGNERS WORK PERMIT（WORKING PERIOD OF MORE THAN 90 DAYS）外国人工作许可证号CURRENT WORK PERMIT不需填写，系统自动生成NUMBER姓（如护照所示）SMITH名（如护照所示）FIRSTBOBAND MIDDLE NAMES (AsSURNAME (As in Passport)in Passport)别名或曾用名（英文）中文姓名 CHINESE照片 PHOTOOTHER NAME USEDNAME性别 GENDER男国籍

2、 NATIONALITY美国出生日期 DATE OF1985-01-01婚姻状况 MARITAL未婚BIRTH(yyyy-mm-dd)STATUS护照类型普通护照护照号码123456789护照签发日期2017-01-01PASSPORT TYPEPASSPORT NUMBERISSUANCE DATE护照有效期至2027-01-01最高学位（学历）大学本科汉语水平不会EXPIRATIONHIGHEST ACADEMICCHINESE PROFICIENCYDATE(yyyy-mm-dd)DEGREE是否持有境外职业资格否职业资格证书名称和编证书 HAVE YOU

3、EVER号 NAME AND NUMBEROBTAINED ANY申请人电子邮箱OF PROFESSIONALPROFESSIONALE-MAIL ADDRESSQUALIFICATIONQUALIFICATIONCERTIFICATESCERTIFICATE ABROAD?列出所有曾授予你护照美国工作年限1教学人员的国家 LIST ALL工作岗位（职业）LENGTH OF WORKINGCOUNTRIES THAT EVEROCCUPATIONTIMEISSUED YOU A PASSPORT聘用合同/任职证明在华2018-01-01申请在中国工作职务英语教师所属行业 INDUSTRY工作起

4、始时间 INTENTEDINTENTED JOB TITLE INCATEGORYWORKING TIME IN CHINACHINA境内用人单位直接聘用8000公认职业成就聘用方式薪酬RECOGNIZEDEMPLOYMENT METHODSALARY(monthly)PROFESSIONALACHIEVEMENT申请在华工作时间2018-01-01至2019-01-01每年在华工作时间12是否毕业于世界知名大学否ARE YOU GRADUATEDINTENTED LENGTH OF（月)WORKING TIME INFROM WORLD RENOWNEDWORKING TIME IN CHI

5、NACHINA PER YEAR(months)UNIVERSITIES是否需要行业主管部门否批准 DO YOU NEED行业主管部门名称行业主管部门批准证书文APPROVAL FROMNAME OF INDUSTRY号 APPROVALRELATED CHINESEAUTHORITYDOCUMENT NUMBERINDUSTRY AUTHORITY?是否持有中国职业资格否职业资格证书（准入类）证书（准入类）HAVE YOU职业资格证书号码名称EVER OBTAINED ANYNUMBER OF CHINESENAME OF CHINESECHINESE PROFESSIONALPROFESS

6、IONALPROFESSIONALQUALIFICATIONQUALIFICATIONQUALIFICATIONCERTIFICATES OBTAINEDCERTIFICATECERTIFICATES(For(For Vocational Accession )?Vocational Accessio)是否曾在世界 500 强企否五年以下业、知名金融机构或律师事务所等任职 DO YOU在上述单位曾担任最高已连续在华工作年限HAVE ANY EXPERIENCE职务 HIGHEST POSITIONIN WORLD TOP 500YOU HAVE EVER HELD INCONSECUTIVE

7、WORKINGCOMPANIES,WELL-KNOWAFOREMENTIONEDYEARS IN CHINAN FINANCIALORGANIZATIONSINSTITUTIONS ORLAWFIRMS?境外派遣单位名称派遣单位所在国家是否有专利等知识产权否LOCATION OFPOSSESS ANY PATENT ORNAME OF DISPATCHINGDISPATCHINGOTHER INTELLECTUALINSTITUTION ABROADINSTITUTION ABROADPROPERTY RIGHTS在中国工作电话xxxx-xxxxxxxxBUSINESS在中国工作任务 JOBT

8、ELEPHONENUMBER INDESCRIPTION IN CHINACHINA列出曾就读的高等教育学校（含职业教育学校，如无高等教育经历，请填写最高学历）LIST ALL HIGHER EDUCATIONAL INSTITUTIONS YOU HAVE ATTENTED (INCLUDING VOCATIONALINSTITUTIONS)名称所在国家就读时间专业学位DATES OFNAMELOCATIONSPECIALITYACADEMIC QUALIFICATIONATTENDANCExx大学 美国2003-09至2008-10儿童研究文学学士列出曾工作的单位(近十年内)LIST AL

9、L EMPLOYERS YOU HAVE WORKED FOR IN LAST TEN YEARS名称工作所在国起止时间工作岗位职务工作任务NAME家 LOCATIONDATESOCCUPATIONJOB TITLEJOB DESRIPTION英语教育中心柬埔寨2017-11至2018-03TEFL老师教师教授学生英文课程随行家属情况 ACCOMPANYING FAMILY MEMBERS是否有家属随行否人数 NUMBERDO YOU HAVE ANYOF THEACCOMPANYINGACCOMPANYINMEMBER?G MEMBERS随行家属姓名出生日期与申请人关系DATE OF性别国籍

10、护照号码NAME (As inRELATIONSHIP TOBIRTH(yyyy-GENDERNATIONALITYPASSPORT NUMBERPassport)THE APPLICANTmm-dd)在华紧急联系人 王XX 联系电话 12345678912345QQ.comEMERGENCY电子邮箱EMERGENCYCONTACTCONTACT PERSONE-MAILADDRESSTELEPHONEIN CHINANUMBER42申领外国人工作许可证APPLICATION FOR FOREIGNERS WORK PERMIT入境时间 DATE OF持有签证种类签证号码 VISATYPE O

11、F VISAENTRYNUMBERHELD您是否由于犯有任何罪行而曾经被逮捕或被判有罪，即使后来得到了赦免或收回是 YES等其他类似措施？HAVE YOU EVER BEEN ARRESTED OR CONVICTED FOR ANY否 NOOFFENSE OR CRIME, EVEN THOUGH SUBJECT OF A PARDON, AMNESTY OR OTHERSIMILAR LEGAL ACTION?您是否曾感染过对公共健康有影响的传染病或患过可造成危险的身体疾病或精神是 YES病？HAVE YOU EVER BEEN AFFLICTED WITH A COMMUNICABLE

12、DISEASE OF PUBLIC否 NOHEALTH SIGNIFICANCE OR A DANGEROUS PHYSICAL OR MENTAL DISORDER?您是否曾违反中国法律，被中国政府递解出境？是 YESHAVE YOU EVER VIOLATED THE LAW OF CHINA, AND DEPORTED FROM CHINA?否 NO本人郑重承诺，在本国及境外无犯罪记录，来华工作后，将严格遵守中国法律法规，自觉服从聘请单位各项管理制度。本申请表上所做之回答均属事实且详尽，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。对所提交的全部申请信息和附件

13、授权可以调查，包括我的雇佣情况、工作表现、工作能力、教育、个人经历和无犯罪记录。如果我已超过 60 周岁，确保在中国工作期间有相应的医疗保险。I SOLEMNLY PROMISE THAT I HAVE NO CRIMINAL RECORD BOTH AT MY HOME COUNTRY AND ABROADWHEN I ARRIVE IN CHINA AND START TO WORK, I WILL STRICTLY ABIDE BY THE CHINESE LAWS ANDREGULATIONS, AND CONSCIOUSLY OBEY THE MANAGEMENT SYSTEM OF

14、 THE EMPLOYING INSTITUTION.CERTIFY THAT ALL THE ANSWERS TO THIS APPLICATION AND RELEVANT ATTACHMENTS TO IT ARE TRUEAND COMPLETED. IF THE INFORMATION IS FOUND TO BE UNTRUE OR UNCOMPLETED, I AM AWARE THATNEEDTOUNDERTAKECORRESPONDINGLEGALRESPONSIBILITIES.IUNDERSTANDTHATALLOFTHEINFORMATIONINTHISAPPLICAT

15、IONANDDOCUMENTSSUBMITTEDWITHTHISAPPLICATIONMAYBECHECKEDBYRELEVANTPARTIES,INCLUDINGMYEMPLOYMENT,WORKPERFORMANCE,ABILITIES,EDUCATION,PERSONALEXPERIENCESANDCONVICTIONRECORDS.ICONFIRMTHAT, IF I AM OVER SIXTY YEARS OLD,I WILL APPLY FOR MEDICAL INSURANCE COVERAGE AS ARE NEEDEDDURING MY WORK PERIOD IN CHIN

16、A申请人签名 SIGNATURE OF APPLICANT 日期 DATE(yyyy-mm-dd)用人单位承诺如实向行政机关提交有关材料和反映真实情况，并对申请材料实质内容的真实性负责,承担相关法律责任。THE EMPLOYER HEREBY DECLARES THAT ALL THE DOCUMENTS AND INFORMATIONS SUBMITTED TO THEAUTHORITY ARE TRUE,AND SHALL BE RESPONSIBLE TO THE AUTHENTICITY OF THE DOCUMENTS ANDUNDERTAKE CORRESPONDING LEGAL RESPONSIBILITIES用人单位公章SEAL OF EMPLOYER日期DATE(yyyy-mm-dd)