Professional Documents
Culture Documents
Extra Jurisdiction - Essential Information Checklist OCT2013
Extra Jurisdiction - Essential Information Checklist OCT2013
Extra Jurisdiction - Essential Information Checklist OCT2013
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:
|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|
Number and Street Name City Province/State Postal/Zip Code
|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|
Number and Street Name City Province/State Postal/Zip Code
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
Surname First Name Middle Names (separate by comma)
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
Surname First Name Middle Names (separate by comma)
I declare that I have per sonally known:
Surname First Name Middle Names (separate by comma)
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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Strictly Private and Confidential
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Page 3 / 8
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Page 4 / 8
Strictly Private and Confidential
(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
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* 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
Strictly Private and Confidential
(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).
I hereby consent to the above. I do not consent to the above.
Page 6 / 8
Strictly Private and Confidential
(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.]
Duration of the Provision:
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
Strictly Private and Confidential
(when completed)
acquiring and submitting my personal information.
I hereby consent to the above. I do not consent to the above.
<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.
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 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 consent to the above. I do not consent to the above.
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
Strictly Private and Confidential
(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.