姓名Name in full

性别Sex

国籍Nationality

婚姻状况Marital status

照片

Photo

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 tell 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

平均月工资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 labor administrative department

 签字（盖章）

Signature (seal)

　　　　  　　　　 　 年 月 日

　　　　　　　　　  　yr math day

受理日期Date of Accepted

答复日期Date of Reply