Questionnaire on personal information UDENRIGSMINISTERIET MINISTRY OF FOREIGN AFFAIRS OF DENMARK Position: Arkivmedarbejder Person type: Eksternt tilknyret Place of employment: Iron Mountain 4. Introduction {Questionnaire on personal information regarding security clearance related to possible employment in or in association with the Danish Ministry of Foreign Affai (Cf. Circular CIS No, 10338 of 17 December 2014 regarding the protection of information of commen interest to countries within NATO or the EU, other classified information, and other information which for security reasons should be protected, Please nate ‘+ Danish applicants should fill out the questionnaire in Danish, + Click Next after each section, to save the current state of the questionnaire and continue to the next section. You can close the ‘questionnaire at any time -if you return later, you will continue from where you left. + When the questionnaire has been submitted (by pressing the button inte last section) it will no longer be editable. 2.Photo 3. Personal Information Firstname lonut Middle name Nicusor Last name Creange Sex Mand Ihave a Danish CPR number Yes CPRnumber 190496273 Romania (current). Vaslui Romania 4. Contact Information Tel. home 91274860 Mobile Tel. workEmail ionutnick@yahoocom Addresses County Road Houseno Flocr Door Zipcode city 0 Denmark Bregentvedve) 22 stth 4590 Haslev 5. Marital Status ‘Marital Status Married / Registered partnership ‘My partner lives with me Yes Partner Information or REED Birthdate First name Eresebet Middle name Tunde Lastname Creanga Kvinde Phone 50181929 Emai elkomaromi@yahoo.dk Place of Birth Carel Nationality Romania Occupation Lagermedarbejéer (My partner has lived outside her No ‘current residential country within the last 10 years 6. Cohabitants Please note: cohabitants should only be listed for Danish addresses. Please list all others that are currently living at your address. NB: not yourself, your partner or your children. However, children over the age of 18 are still required to be listed. Ifthe person in question does not have @ Danish CPR-number, please enter hisyher date of birth (DD/MM/YYYY). None 7.Relatives and Aquaintances Please register close relatives or acquaintances, if any, employed by a public authority in Denmark by clicking the ‘Add person’ button. Otherwise, click ‘Next: None 8. Items of debt Altitems of debt must be listed. Indicate in each case the type of debt, the size of the debt, the name of the creditor and any comments you ‘might have concerning the debt ‘Type of loan Amount Currency Creditor Comments carloan 159361 DKK Santander Consumer Bank 9. Periods Abroad List any longer stays abroad, State the time period, the purpose and the exact residential address(es) of your stay. Please note: do not include short-term holidays. None10. Employment State current employment and other employment including military service, you have had during the last 10 years. List the employment in a chronological order, starting with your eurrent occupation. Please note: periods without occupation during the last 10 years must also be noted. Employment Fromdate Todate Position Company name Contact person Details of contact person Current 10-02-2013 Gaffetruck Profilmatch ApS Alice 8. (32323314) consultant and human ‘employment operator Stationsparken 25 profilmatch@profilmatch dk resources tw. 2600 Glostrup My current employer may Denmati bbe contacted Period without 11-10-2009 10-02-2013 ‘employment 11. Education Please note: only lst education from the ast 10 yeors List education in a chronological order, starting with your most recent education. 12. Additional CommentsStatement by employer Please note: Do not fll inthis section if you have applied for 1) new employment with the Danish Ministry of Foreign Affairs/at a Danish mission smship at a Danish mission abroad. Inall other cases, your employer must ill in this section. Ths indludes technicians, craftsmen, consultants, external advisors or employees working {or an incubator. NOTE! This section must also be filled in in relation to a renewal or upgrade of your current security clearance, Weare not aware ofany circumstances which would suggest thatthe requested security learance should not be granted to the applicant who has ‘bsen an employee of his company since DDN YYYY. "Name of company (stamp or capital letters) Date (DO/MMYYYY) "Name and title (capital letters) and signature Waiver of confidentiality Jonut Nicusor Creanga (Applicant) {hereby accept that as part of the security clearance procedure, information about me will be obtained and passed on in accordance with the procedure described below. Date. Signature Erzsebet Tunde Creanga (Spouse / Reg. partner) I hereby accept that as part ofthe application for a security clearance procedure as submitted by my spouse/registered partner/cohabitant, information about me may be obtained and passed on to the same extent as about my spouse/registered partner/cohabitant in accordance with the procedure described below. | urthermare accept that the Danish Security and Intelligence Service (PET) may pass information about me to the candidate in the matter of the security dearance. Date. Signature, For the purpose of assessing whether an individual may be granted security dearance, the authority responsible for making this decision the authorising authority) will obtain information about the applicant from the Danish Security and intelligence Service (PED). As part of this procedure, the authority will frward the completed information sheet to PET, including the company's endorsement regarding the applicant's cligiblity for the relevant level of security dearance, ‘Based on the approach from the authorising authority, PET will run a trace in the police records for information on the applicant, including information concerning any criminal convictions aleahol or drug abuse, and any court appearances by order ofthe police. Furthermore, PET will tun a trace in its own records for any security-related information. PET will also obtain information from previous employers, educational institutions as well as clase relatives and acquaintances employed by a public authority. As part ofthis procedure, PET may, for example, cbtain formation about any financial problems or information of a strictly private nature, induding information regarding any criminal offences or any alcohol or drug abuse. In addition, PET will obtain information concerning the applicant’ financial situation, including information regarding property and income, from the tax authorities. Ifthe applicant is residing or staying abroad — or in recent years has been staying or residing abroad for extended periods of time PET will also ‘obtain information regarding any criminal offences as well as security-related information from the police and security authorities of the relevant country/countties {the applicant has been or currently is a citizen of a country other than Denmark, PET wil furthermore, obtain any relevant files from the immigration authorities. If the decision regarding security clearance is made by another authority | hereby also accept that PET may pass on the above-mentioned information to the authorising authority to the extent deemed necessary by PET in order forthe athority in question to make an informed decision about security clearance.Declaration of Confidentiality |. the undersigned, do hereby, under the terms of my security clearance, pledge to keep in strictest confidence any information, the secrecy of which is requried by Statue or nature, that may become known to me, further dedlare that | have been made familiar with the provisions of Section 27 of the Danish Public Administrations Act and Sections 144-145, 147-152 f and 155-157 of ‘the Danish Criminal Code; copies of which Ihave received, | accept that this obligation to maintain secrecy and confidentiality shall emain in force ‘even wien the activity/actvities subject to this security clearance have ceased. Date and place Civil registration No SignaturePublic Administration Aet $5.27 (D) 2ay person acing within the public aéminisvation is bound by Drofessional secrey, ct. Secton 152 and Sections 152¢-1521 ofthe Danish Criminal Code, whenever information is designsted as cofiential by statite or ‘other legally incing prowsion or wnanevar ts atheruize necessary te keen the Information secret te protect material publ or private interests, indung parca 1) the cecurty af the State and the defence of he realms 2) Oris foreig picy and Danichescernal economic tress inclucing relations wn foreign pavers ‘and irtemation|instutons; 3) Prevention and cering-up of any iingemert of the law, prosecution ef fenders, execution af sernences andthe Ie, and protection of persansscaused, cf witnesses and ater: in matters ef ciminal oF ‘eiplinryproseasion; 4) impleertstion of publ superision, contra Fegulston an planing acities ana ef measires planned under taxon la 5) brotection of publ financial mere, incuing interes relating to public {ommeril ative 6) the interests of incl persons or priate enterprises lr sacieies in protecing information on ther personal or internal incising Fnancial circumstances: and 7) he financial interests of incvicual persons rua enterprises or sods in protecting information on techricl devices or Drocesses or on business a operation pracedures and pices. (2) Any person ating wahin the pubic administration maybe ordered 0 maintain profesional secre respect of any particular piece of rfermation only when ‘Secrecy i equed To protect material public or private terest 95 tse in subsection (7) ofthis Section, (@) An administration authority may bind 3 person ousie te public ‘ministration to secre respect of anj confidential information passed on by the authory tothe person concerned without the authory beng ablged to do (where reson seeecy are provided by vitue of the provision of subsection (2) of Section 1 ofthis Act, or secrecy by vite of the provision of subsection (3) ofthis Sections enjoined secon 152 and Sections 152-12 efthe Danish Criminal code shal apply corresponcinay 10 any infsingemert af such ries or cexjoinmerts ‘timinal Code '5 144 Any person who, while exeresing @ Danish, foreign or interational public office or function unlanuly receives, demands, or acerts the promise ofa gift (rather Favour shal be lable to ine or te imprisonment for any fer not fevceeding si years. ‘S145 any person exercising a pul office or function demande or accepts, for the purpase af personal gain a fe in respect fan affal function a atx or charge nat due he shall Be ble toa fine orto impizonment foray term net exceeding sie years If forthe purpose ef personal gain he keeps such remuneration uhich he received in goed fath, after he has become auare ofthe ‘iste, he chal be lable to eer to imprisanment for an) term nat exceeding to years. ' 1471 any person whose duty ico enforce the punitive power ofthe state ‘opis, fr that purpose unlawful means wih a ew to obtaining 9 conession oF evidence, or he undertakes any unlawful arest,mprisonment, search or slave, he shal belle to afin oft imprconment for any term rat exceeding nee years ‘51481 any person in whom junsdicton or ether public power to decide lege ‘ese ie vetted or whose yet enforce the puntve power ofthe sate fa, Intenonall er through grass negligence, to observ the procedure provided by lan, a5 regards the examination ofthe case or the exectton of certain uncial 2c oF nrespect of arest imprisonment search setzure oF measures ef 3 ‘Sir nature he shall be liable to a ine orto imprisonment for any erm nck ‘exceeding four mont ‘5149 any person responsible fer the custody ofa prizoner or for the earning fut of sentences alloys an accused person to escape, prevents the carrying out of a sentence. or unlavtuly causes a mitigation of he serving of ‘the imposed certence he shall be Habe toa ne orto imprisonment for an tec not exceeding tree years 5 150 any person exercising 2 public cffce or functon abuses his poston to {ores any person to Go suet oF mvt co anh. he shal be babe to imprsoamert for any term not exceeding three years. |S 151 ay person wna sd ar abet: asuborsinate in «publ fie ar ncn to ‘commit a punishable actin this sence punish, regards: of whether the ‘Subordinate i ubjecte punishment ar ening te ignarance or fr any ether eaten i exonerted pursuat tthe proiion tat concerns the cence, '$182 1 Any person who is exercising or ho has exercised a public ofice oF function, and io until Forwards or expla concent information which he has dtaned in connection with his offence ot function, shall be Habe Ya 2 ine ‘orto imorsonment foray term nat exceeding ix months.) the offence as ‘mentioned in Subsection (fs commited withthe intent to obtain an nla {ain for inset af for otters, orf ether parila aggravatng cecumstances fate present the pealy may be increased te imprisonment for any term not fexceecng two yrs. @) information i conden when made £0 nat Kt or by ‘othe stipulations. or whe ti necessary to keep ka Sere inorder to protect important pubic or private interes. '$152.4 (1) The provisions in Sections 15252 cof this Act hal similar apply to any person wh, vitheut having particpated ithe at nial obtains oF ‘ret informaton that has been obtained through the commiting of such an ac. @) The same pena shal apply te any person wo, wihout having Pattiopated inthe ect unanfully fares infomation cencerng anther person's sty private fe (according to Section 28(1) ofthe Puble ‘Administration At, which has been obtained through commiting an act punishable acorcing to Sections 152-152 cof his Ac (3) The same provisions Shall apply fo ary person, who without havg partpated in the act unlawtuly ‘onward formato whe conidetal because offs importance to the safety ofthe state orto the protection of state defence '$152.e The provisions in Sections 152-152 of his Act do not apply in cases ‘where the person in question 1) was under an obligation te forward the information: ar 2 acted in order to lal safecusra obvious public itrests or the irterest of isa or ether persone ‘5182 £1) ete only priate nerests have been offended, cotravetin of Sedions 182-152 ¢ of his acs subject to private prosecution. @) Pubic proseoston ay be instigated athe request of the ijuted party, ‘51551 any person exercising 2 public office o uncon abuses his postion to ‘olate the rights of ary prvate person or of any pubic authoty, ne shall be Fable oa fine or fo mprisonment for any term not excesdng four moths Where he commis such abuse im order to obtain an unlanul privige fr hime corfer oters, a pena of imprisonment for any tm nat excaecing two years may be imposed, 5 156 any person exercising a public ofce or function refuses or fal to ft ‘any iy involved! by the ofes or function ote comely wh any lf ficial Corder, he sal be lable to 2 fie orto imprscnment for any term nat exceeding four mame the foregoing provision shal not apply ta functions the ffimen of ‘which i based on publ elections '$187 any person exarcsing 2 publi office o uncon is guy ofa serious oF ‘often repeated breach of duty or carelessness in carrying out he office °the function or inthe observance othe duties here in he office or the function he shall be ible to a ine or 10 npizonment fr any ter not exceesing Yow ‘months, chided from the previous prowsions are dates, the performance of wich relies on pubic elections.