外国人来华工作许可申请表

APPLICATION FORM FOR FOREIGNER'S WORK PERMIT

申请编号
370000120220333115
APPLICATION NO
姓（如护照所示） 名（如护照所示）
SURNAME (As in LAGOIDA FIRST AND MIDDLE ILIA
Passport) NAMES (As in Passport)
中文姓名（仅外籍华人）
别名或曾用名（英文）
OTHER NAME USED CHINESE NAME
(Foreign Chinese Only)
性别 男 国籍 俄罗斯
GENDER NATIONALITY

出生日期 1992-07 婚姻状况

DATE OF BIRTH(yy 已婚
yy-mm-dd) -19 MARITAL STATUS

护照类型 普通护 护照号码 75 护照签发日期 2017-05-1

PASSPORT TYPE 照 PASSPORT NUMBER 4913018 ISSUANCE DATE 8
护照有效期至 2027-05 最高学位（学历） 汉语水平
EXPIRATION HIGHEST ACADEMIC 博士 其他
DATE(yyyy-mm-dd) -18 DEGREE CHINESE PROFICIENCY
是否持有境外职业资格证
职业资格证书名称和编
书 HAVE YOU EVER 号 NAME AND iliyalago
OBTAINED ANY
PROFESSIONA L 否 NUMBER OF 申请人电子邮箱 ida@gmail
PROFESSIONA L E-MAIL ADDRESS
QUALIFICATION QUALIFICATION .com
CERTIFICATE
ABROAD? CERTIFICATES
列出所有曾授予你护照的
工作年限 WORKING
国家 LIST ALL EXPERIENCE AND 工作岗位（职业） 科学研究
COUNTRIES THAT 俄罗斯 3
EVER ISSUED YOU A LENGTH OF OCCUPATION 人员
WORKING TIME
PASSPORT
聘用合同/任职证明在华 申请在中国工作职务 助理研究
工作起始时间 INTENDED 2021-06 所属行业 INDUSTRY
INTENDED JOB TITLE
WORKING TIME IN -01 IN CHINA 员 CATEGORY
CHINA
境内用 公认职业成就
聘用方式 EMPLOYMENT 人单位 25000 RECOGNIZED
METHOD 直接聘 薪酬 SALARY(monthly) PROFESSIONA L
用 ACHIEVEM ENT
2022-07 是否毕业于世界知名大学
每年在华工作时间
申请在华工作时间 -17 至 IF YOU ARE
INTENDED WORKING （月)WORKING TIME 12 GRADUATED FROM 否
TIME IN CHINA 2024-06 IN CHINA PER
WORLD RENOWNED
YEAR(months)
-01 UNIVERSITIES
是否需要行业主管部门批
准 HAVE YOU
OBTAINED APPROVAL 行业主管部门名称 行业主管部门批准证书文
否 NAME OF INDUSTRY 号 APPROVAL
FROM RELATED AUTHORITY DOCUMENT NUMBER
CHINESE INDUSTRY
AUTHORITY?
是否持有中国职业资格证 职业资格证书（准入类） 职业资格证书号码
书（准入类）HAVE YOU
EVER OBTAINED ANY 名称 NAME OF NUMBER OF CHINESE
CHINESE PROFESSIONA L
CHINESE 否 PROFESSIONA L QUALIFICATION
PROFESSIONA L
QUALIFICATION QUALIFICATION CERTIFICATESOBTAINE
CERTIFICATES(for D
CERTIFICATE (for industry access) (for industry access)
industry access)?
是否曾在世界 500 强企
业、知名金融机构或律师
在上述单位曾担任最
事务所等任职 DO YOU 高职务 HIGHEST
HAVE ANY
EXPERIENCE IN POSITION YOU
否 HAVE EVER HELD
WORLD TOP 500 IN
COMPANIES,WELL-KN
OWN FINANCIAL AFOREMENTIONED
ORGANIZATIONS
INSTITUTIONS OR
LAWFIRMS?
是否有专利等知识产权
IS THERE A PATENT 已连续在华工作年限
否 CONSECUTIVE 五年以下
AND OTHER WORKING YEARS IN
INTELLECTUA L
PROPERTY RIGHTS CHINA
派遣单位所在国家
境外派遣单位名称
NAME OF LOCATION OF
DISPATCHING
DISPATCHING INSTITUTION
INSTITUTION ABROAD
ABROAD
在中国工作电话 在中国工作任务 JOB
BUSINESS 053188797160 DESCRIPTION IN
TELEPHONENUM BER CHINA
IN CHINA
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 EDUCATIONA L INSTITUTIONS YOU HAVE ATTENTED (INCLUDING VOCATIONA L
INSTITUTIONS)

名称 所在国家 就读时间 学位
专业 SPECIALITY ACADEMIC
NAME LOCATION DATES OF ATTENDANCE QUALIFICATION
National Research
Nuclear 俄罗斯 2014-07 至 2016-07 Nuclear Physics and 硕士
University Technology
“MEPhi”
National Research
Nuclear 俄罗斯 2016-07 至 2020-07 Physics and 博士
University Astronomy
“MEPhi”
列出曾工作的单位(近十年内)
LIST ALL EMPLOYERS YOU HAVE WORKED FOR IN LAST TEN YEARS

工作所在国
名称 起止时间 工作岗位 职务 工作任务
NAME 家 DATES OCCUPATION JOB TITLE JOB DESRIPTION
LOCATION
National Research
Nuclear 2014-07 至 Data Analysis and
俄罗斯 Engineer Engineer
University 2022-03 Teaching Assistant
“MEPhi”
LLC
Technoanalytdevic 俄罗斯 2016-07 至 C/C++ C/C++ Developer Software
2022-03 Developer Development
e
随行家属情况 ACCOMPANYING FAMILY MEMBERS
是否有家属随行 DO 是 人数 NUMBER 3
YOU HAVE ANY OF THE
ACCOMPANYING ACCOMPANYI
MEMBER? NG MEMBERS
出生日期
随行家属姓名 DATE OF 性别 国籍 与申请人关系 护照号码
NAME (As in RELATIONSHIP TO
Passport) BIRTH(yyyy GENDER NATIONALITY THE APPLICANT PASSPORT NUMBER
-mm-dd)
ANNA LAGOIDA 1995-09-08 女 俄罗斯 配偶 76 4466129

ILIA LAGOIDA 2020-10-03 男 俄罗斯 子女 76 4380604

MISHA LAGOIDA 2017-07-31 女 俄罗斯 子女 76 4380596

在华紧急联系人 联系电话
EMERGENC 电子邮箱 E-MAIL
EMERGENCY Y CONTACT
CONTACT ADDRESS
PERSON IN CHINA TELEPHONE
NUMBER
申领外国人工作许可证
APPLICATION FOR FOREIGNER'S WORK PERMIT
持有签证种类
入境时间 签证号码 VISA
DATE OF ENTRY TYPE OF NUMBER
VISA HELD
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等其他 □是 YES
类似措施？HAVE YOU EVER BEEN ARRESTED OR CONVICTED FOR ANY
OFFENSE OR CRIME, EVEN THOUGH SUBJECT OF A PARDON, AMNESTY OR ☑否 NO
OTHER SIMILAR 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病？ □是 YES
HAVE YOU EVER BEEN AFFLICTED WITH A COMMUNICABLE DISEASE OF
PUBLIC HEALTH SIGNIFICANCE OR A DANGEROUS PHYSICAL OR MENTAL
DISORDER? ☑否 NO

您是否曾违反中国法律，被中国政府递解出境？HAVE YOU EVER VIOLATED THE □是 YES

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 ABROAD. WHEN I ARRIVE IN
CHINA AND ST ART TO WORK, I WILL ST RICTLY ABIDE BY T HE CHINESE LAWS AND REGULATIONS, AND CONSCIOUSLY
OBEY T HE MANAGEMENT SYST EM OF THE EMPLOYING INST ITUTION. I CERTIFY THAT ALL T HE ANSWERS T O T HIS
APPLICATION AND RELEVANT ATTACHMENTS T O IT ARE T RUE AND COMPLETED. IF T HE INFORMATION IS FOUND T O BE
UNT RUE OR UNCOMPLETED, I AM AWARE T HAT I NEED TO UNDERTAKE CORRESPONDING LEGAL RESPONSIBILITIES.I
UNDERST AND T HAT ALL OF THE INFORMATION IN THIS APPLICATION AND DOCUMENTS SUBMITTEDWITH T HIS
APPLICATION MAY BE CHECKED BY RELEVANT PARTIES, INCLUDINGMY EMPLOYMENT, WORK
PERFORMANCE,ABILITIES,EDUCATION,PERSONAL EXPERIENCES AND CONVICT ION RECORDS.I CONFIRM T HAT, IF I AM
OVER SIXT Y YEARS OLD,I WILL APPLY FOR MEDICAL INSURANCE COVERAGE AS ARE NEEDED DURING MY WORK PERIOD
IN CHINA.

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。
T HE EMPLOYER HEREBY DECLARES T HAT ALL THE DOCUMENTS AND INFORMATIONS SUBMIT TED TO THE AUTHORITY
ARE T RUE,AND SHALL BE RESPONSIBLE TO THE AUTHENTICITY OF T HE DOCUMENTS AND UNDERTAKE CORRESPONDING
LEGAL RESPONSIBILITIES.

用人单位公章（Seal of Employer）

年 月 日
YYYY MM DD