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별표·별지28건 · 보관 28건

별표 제1호기본분류지침표(제10조 관련)표로 보기hwp 내려받기
별표 제2호정보통신보안 규정 위반 사항(제39조의2 제1항 관련)표로 보기hwp 내려받기
서식 제1호비밀등급표(비밀표지)표로 보기hwp 내려받기
서식 제2호비밀등급표(비밀표지)표로 보기hwp 내려받기
서식 제3호비밀등급표(비밀표지)표로 보기hwp 내려받기
서식 제4호비밀등급표(비밀표지)표로 보기hwp 내려받기
서식 제5호I급 및 II급비밀(이중봉투)표로 보기hwp 내려받기
서식 제6호접수증표로 보기hwp 내려받기
서식 제7호비밀보관 책임자명부표로 보기hwp 내려받기
서식 제8호비밀관리기록부표로 보기hwp 내려받기
서식 제9호비밀문서 수발기록부표로 보기hwp 내려받기
서식 제10호비밀발간승인 신청서표로 보기hwp 내려받기
서식 제11호비밀발간통제부표로 보기hwp 내려받기
서식 제12호비밀열람기록전표로 보기hwp 내려받기
서식 제13호비밀대출부표로 보기hwp 내려받기
서식 제14호비밀작업일지표로 보기hwp 내려받기
서식 제15호비밀반출승인서표로 보기hwp 내려받기
서식 제16호비밀소유현황표로 보기hwp 내려받기
서식 제17호제한구역, 통제구역, 출입자 기록부표로 보기hwp 내려받기
서식 제18호신원조사 대상자 명단표로 보기hwp 내려받기
서식 제19호신원진술서표로 보기hwp 내려받기
서식 제20호신원진술서(약식)표로 보기hwp 내려받기
서식 제21호PERSONAL QUESTIONNAIRE표로 보기hwp 내려받기
서식 제22호신원대장표로 보기hwp 내려받기
서식 제23호신원특이자명부표로 보기hwp 내려받기
서식 제24호서약서표로 보기hwp 내려받기
서식 제25호비밀취급 인가증표로 보기hwp 내려받기
서식 제26호비밀취급 인가자 현황표로 보기hwp 내려받기

서식 제21호PERSONAL QUESTIONNAIRE

표 3개 · 방금 변환원본 hwp 내려받기닫기
[별지 제21호 서식] <개정 2022. 4. 6.>
(1st page)
PERSONAL QUESTIONNAIRE
* FOR OFFICIAL USE ONLY		[PHOTO]
or photo file
(3㎝×4㎝)ㆍ
(3.5㎝×4.5㎝)
NAMELast/First/MiddleGENDER
DATE OF
BIRTH		Month/Day/Year
NATIONALITY
(Include any dual nationality)		PLACE OF
BIRTH		City/Country
ALIEN
REGISTRATION
NUMBER		DATE &
PLACE OF
ENTRY TO
KOREA		Month/Day/Year City/Country
RESIDENTIAL
ADDRESS
IN KOREA
WORKPLACEJOB/TITLE
TELEPHONE
NUMBERS
(Include Area Code)		OFFICE : MOBILE :
EDUCATIONSCHOOL
NAME		PERIOD
(MM/YY-MM/YY)		TYPE
OF
DEGREE		MAJORLOCATION
(City/Country)
210mm×297mm [백상지(80/㎡) 또는 중질지(80/㎡)]
(2nd page)
EMPLOYMENT
HISTORY
&
PARTICIPATION
IN CIVIC/POLITICAL ASSOCIATION		EMPLOYER/
VERIFIER NAME		PERIOD
(MM/YY-MM/YY)		JOB TITLE/
POSITION		LOCATION
(City/Country)		REWARD &
PUNISHMENT
(MM/YY)
FAMILY
INFORMATION		RELATIONNAME
Last/First/Middle		DATE OF BIRTHFINAL
ACADEMIC
DEGREE		CAREERADDRESS
RELATIVES
&
ASSOCIATES
IN KOREA		RELATIONNAME
Last/First/Middle		CAREERJOB TITLE/
POSITION		TELEPHONE
NUMBER
I declare that statements made in this form are true and correct, and agree if false information is knowingly or willingly provided on this form, I can be penalized in accordance with the relevant statute.

DATE :
SIGNATURE :
210mm×297mm [백상지(80/㎡) 또는 중질지(80/㎡)]
(3rd page)
Consent to the Collection and Use of Personal Information
The National Intelligence Service, Ministry of National Defense, and National Police Agency intend to collect and use personal information, sensitive information, and personally identifiable information of the applicant for the conduction of background check pursuant to Article 46 (Processing of Personally Identifiable Information) of the "Regulations on Security Work," and Article 15 (Collection and Use of Personal Information), Article 23 (Limitation to Processing of Sensitive Information), and Article 24 (Limitation to Processing of Personally Identifiable Information) of the "Personal Information Protection Act."
■ Collection and use of personal information

※ The above is the minimum information required to carry out background check and the applicant has the right to refuse the collection and use of personal information. However, in case of refusal, there may be restrictions in appointment (employment) and security clearance, as background check cannot be carried out pursuant to "Regulations on Security Work."
☞ I agree to the collection and use of personal information as described above. I agree [ ] I do not agree [ ]
ItemsName, gender, photo, nationality, place of birth, alien registration number, date & place of entry to korea, residential address in korea, workplace, job/title, telephone numbers(including office, mobile), education(including school name, period, type of degree, major, location), employment history & participation in civic/political association(including employer/verifier name, period, job title/position, location, reward&punishment), family information(including relation, name, date of birth, final academic degree, career, address), relatives & associates in korea(including relation, name, career, job title/position, telephone number)
Purpose of
collection/use		Background check and verification
Retention/
use period		2 years
■ Processing of sensitive information

※ The above is the minimum information required to carry out background check and the applicant has the right to refuse the processing of sensitive information. However, in case of refusal, there may be restrictions in appointment (employment) and security clearance, as background check cannot be carried out pursuant to "Regulations on Security Work."
☞ I agree to the processing of sensitive information as described above. I agree [ ] I do not agree [ ]
ItemsParticipation in civic/political association
Purpose of
collection/use		Background check and verification
Retention/
use period		2 years
■ Processing of personally identifiable information

※ A separate consent is not required under subparagraph 1 of Article 24-2 (1) of the "Personal Information Protection Act" and Article 46 of the "Regulations on Security Work."
☞ I have read and understood that personally identifiable information will be processed as described above. [ ]
ItemsAlien registration number
Purpose of
collection/use		Background check and verification
Retention/
use period		2 years
We comply with personal information protection regulations that personal information processors are required to follow under the "Personal Information Protection Act." We will protect the rights of the information provider in accordance with relevant laws, and the collected information will not be used for purposes other than reasons agreed to by the information provider.

mm dd, yyyy
Applicant (representative): (seal or signature)
Legal representative (if needed): (seal or signature) Contact information:
210mm×297mm [백상지(80/㎡) 또는 중질지(80/㎡)]

rhwp 0.8.2 (2dced7bfe10c6597cead634264c7c1781c01f1e7)로 변환 · 2026-10-10T16:26:03Z — 표 밖의 문단·이미지·수식은 옮겨지지 않습니다. 원본이 필요하면 위의 내려받기를 쓰세요 또는 PDF 원본 ↗