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Document Type International Release Form Your Name National ID Number

Peoples Republic of China QR Form 101

HireRight is the leading provider of Internet -based employme nt screeni ng services. T he com panys screening se rvices help orga nizations worldwide to quickly, consi stently a nd ea sily hire the best applicants. HireRight verifies information that you have provided as part of your application for employment. In order to complete the verification, we will need additional information from you. Please complete the forms, make clear copies of your passport and diploma/degree, and email or fax all the information to the HireRight as soon as possible. What follows is a checklist to help you with this process. 1. Print the directions and the forms in this document 2. Complete the QR101 form in Chinese characters 3. Sign and date the QR101 form in Chinese characters 4. Make a clear copy of the passport page that has your photograph on it 5. Make a clear copy of your diploma or degree (this will be needed to verify education) 6. Complete the this cover sheet 7. Email or fax t he forms, passport copy a nd diploma copy, and this cove r sheet to HireRight. You can email them to or fax them to (87 7) 797-3442 in the US or +1 (949) 224-6064 outside of the US. If you have questions, please email

If returning this form by email, please attach scanned images that are less than 1MB. China QR101 v1 Rev. 03/09 Page 1 of 3

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 () Hukou Address, Name of Police Office and Hukou Type ( )

.: :

Entity that holds the official personal record file, Contact information & File No. ( ) Can a reference be taken now? ()? If no, when can it be taken? ()? Current Employer () If you are currently living outside the PRC, when did you leave China? ( ) For Students and Graduates whose personal record file are kept at the university only ( )

Yes () No ()

Signed in Chinese ______________ Date _________________

China QR101 v1 Rev. 03/09

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 assignment 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 QR101 v1 Rev. 03/09