中文名

in chinese

出生日期和地点

Date and place of birth

文化程度

Educational Attainment

专业技术特长

Special occupational skills

健康状况

Health condition

在北京的住址、邮编和电话

Address，P. O. Box and Tel No. of the foreigner in Beijing

护照种类

Type of passport

号码

Passport No

有效期

Valid until

发照机关

Issued by

签证种类

Type of visa

号码

Visa No.

有效期

Valid until

签证机关

Issued by

是否提出过延期申请（如果是，详细列出）

Has the foreigner once applied for the extension of employment term?

本国固定住址、邮编和电话

Regular address，P. O. Box and Tel No. in home country

聘用单位的全称和地址

Full name and address of the employing organization

                                                        （聘用单位印章）

邮编

P. O. Box

法定代表人姓名

Name of the Legal Representative

电话

Tel No.

申请人职业

Applicant’s Occupation

月平均工资

Salary per month

原聘用期限至

Expiration Date of Previous Term

申请延期至

Extended until

申请延期的理由

Reason for Extension of Employment Term

劳动行政部门意见

Suggestion by the labour administrative department

经办人：                                 核准人：

Transactor：              People of ratify：

受理日期

Date of Accepted

批准日期

Date of approve