4대보험 미가입자, 사업주 확인이 어려운 경우 이용가능한 사실확인서 서식입니다.＜견본＞

4대보험 미가입자, 사업주 확인이 어려운 경우 이용가능한 사실확인서 서식입니다. 사실확인서상 입증인의 개인정보 제공 동의가 없는 경우 수험자의 경력증명서 심사가 어려움을 알려드립니다. <span style="background: rgb(255, 255, 255); color: rgb(0, 0, 0); letter-spacing: -0.5pt; font-family: Verdana,sans-serif; font-size: 25pt; font-weight: bold; mso-fareast-font-family: 휴먼명조; mso-font-width: 90%;">사 실 확 인 서   <table width="694" style="width: 694px; border-right-color: rgb(0, 0, 0); border-bottom-color: rgb(0, 0, 0); border-left-color: rgb(0, 0, 0); border-right-width: 0.28pt; border-bottom-width: 0.28pt; border-left-width: 0.28pt; border-right-style: solid; border-bottom-style: solid; border-left-style: solid; border-collapse: collapse; mso-table-overlap: never;"><tbody><tr><td valign="middle" style="background: rgb(214, 214, 214); border-width: 1.7pt 0.28pt 0.28pt 1.7pt; border-style: solid; border-color: rgb(0, 0, 0); padding: 1.41pt 2.83pt; width: 83.1pt; height: 17.65pt;">수험자 성명</td><td valign="middle" style="border-width: 1.7pt 0.28pt 0.28pt; border-style: solid; border-color: rgb(0, 0, 0); padding: 1.41pt 2.83pt; width: 156.68pt; height: 17.65pt;" colspan="3">   </td><td valign="middle" style="background: rgb(214, 214, 214); border-width: 1.7pt 0.28pt 0.28pt; border-style: solid; border-color: rgb(0, 0, 0); padding: 1.41pt 2.83pt; width: 88.76pt; height: 17.65pt;" colspan="2">주민등록번호</td><td valign="middle" style="border-width: 1.7pt 1.7pt 0.28pt 0.28pt; border-style: solid; border-color: rgb(0, 0, 0); padding: 1.41pt 2.83pt; width: 143px; height: 17.65pt;" colspan="2">   </td></tr><tr><td valign="middle" style="background: rgb(214, 214, 214); border-width: 0.28pt 0.28pt 0.28pt 1.7pt; border-style: solid; border-color: rgb(0, 0, 0); padding: 1.41pt 2.83pt; width: 83.1pt; height: 17.65pt;">주소</td><td valign="middle" style="padding: 1.41pt 2.83pt; border: 0.28pt solid rgb(0, 0, 0); border-image: none; width: 156.68pt; height: 17.65pt;" colspan="3">   </td><td valign="middle" style="background: rgb(214, 214, 214); padding: 1.41pt 2.83pt; border: 0.28pt solid rgb(0, 0, 0); border-image: none; width: 88.76pt; height: 17.65pt;" colspan="2">연락처(휴대전화)</td><td valign="middle" style="border-width: 0.28pt 1.7pt 0.28pt 0.28pt; border-style: solid; border-color: rgb(0, 0, 0); padding: 1.41pt 2.83pt; width: 143px; height: 17.65pt;" colspan="2">   </td></tr><tr><td valign="middle" style="background: rgb(214, 214, 214); border-width: 0.28pt 0.28pt 0.28pt 1.7pt; border-style: solid; border-color: rgb(0, 0, 0); padding: 1.41pt 2.83pt; width: 117.42pt; height: 17.65pt;" colspan="2">근 무 직 장 명</td><td valign="middle" style="background: rgb(214, 214, 214); padding: 1.41pt 2.83pt; border: 0.28pt solid rgb(0, 0, 0); border-image: none; width: 41.01pt; height: 17.65pt;">직 위</td><td valign="middle" style="background: rgb(214, 214, 214); padding: 1.41pt 2.83pt; border: 0.28pt solid rgb(0, 0, 0); border-image: none; width: 134.4pt; height: 17.65pt;" colspan="2">재 직 기 간</td><td valign="middle" style="background: rgb(214, 214, 214); padding: 1.41pt 2.83pt; border: 0.28pt solid rgb(0, 0, 0); border-image: none; width: 108.93pt; height: 17.65pt;" colspan="2">담당업무내용</td><td valign="middle" style="background: rgb(214, 214, 214); border-width: 0.28pt 1.7pt 0.28pt 0.28pt; border-style: solid; border-color: rgb(0, 0, 0); padding: 1.41pt 2.83pt; width: 49px; height: 17.65pt;">비 고</td></tr><tr><td valign="middle" style="border-width: 0.28pt 0.28pt 0.28pt 1.7pt; border-style: solid; border-color: rgb(0, 0, 0); padding: 1.41pt 2.83pt; width: 117.42pt; height: 17.65pt;" colspan="2">   </td><td valign="middle" style="padding: 1.41pt 2.83pt; border: 0.28pt solid rgb(0, 0, 0); border-image: none; width: 41.01pt; height: 17.65pt;">   </td><td valign="middle" style="padding: 1.41pt 2.83pt; border: 0.28pt solid rgb(0, 0, 0); border-image: none; width: 134.4pt; height: 17.65pt;" colspan="2">년 월 일 ～ 년 월 일</td><td valign="middle" style="padding: 1.41pt 2.83pt; border: 0.28pt solid rgb(0, 0, 0); border-image: none; width: 108.93pt; height: 17.65pt;" colspan="2">   </td><td valign="middle" style="border-width: 0.28pt 1.7pt 0.28pt 0.28pt; border-style: solid; border-color: rgb(0, 0, 0); padding: 1.41pt 2.83pt; width: 49px; height: 17.65pt;">   </td></tr><tr><td valign="middle" style="border-width: 0.28pt 0.28pt 0.28pt 1.7pt; border-style: solid; border-color: rgb(0, 0, 0); padding: 1.41pt 2.83pt; width: 117.42pt; height: 17.65pt;" colspan="2">   </td><td valign="middle" style="padding: 1.41pt 2.83pt; border: 0.28pt solid rgb(0, 0, 0); border-image: none; width: 41.01pt; height: 17.65pt;">   </td><td valign="middle" style="padding: 1.41pt 2.83pt; border: 0.28pt solid rgb(0, 0, 0); border-image: none; width: 134.4pt; height: 17.65pt;" colspan="2">년 월 일 ～ 년 월 일</td><td valign="middle" style="padding: 1.41pt 2.83pt; border: 0.28pt solid rgb(0, 0, 0); border-image: none; width: 108.93pt; height: 17.65pt;" colspan="2">   </td><td valign="middle" style="border-width: 0.28pt 1.7pt 0.28pt 0.28pt; border-style: solid; border-color: rgb(0, 0, 0); padding: 1.41pt 2.83pt; width: 49px; height: 17.65pt;">   </td></tr><tr><td valign="middle" style="border-width: 0.28pt 0.28pt 0.28pt 1.7pt; border-style: solid; border-color: rgb(0, 0, 0); padding: 1.41pt 2.83pt; width: 117.42pt; height: 17.65pt;" colspan="2">   </td><td valign="middle" style="padding: 1.41pt 2.83pt; border: 0.28pt solid rgb(0, 0, 0); border-image: none; width: 41.01pt; height: 17.65pt;">   </td><td valign="middle" style="padding: 1.41pt 2.83pt; border: 0.28pt solid rgb(0, 0, 0); border-image: none; width: 134.4pt; height: 17.65pt;" colspan="2">년 월 일 ～ 년 월 일</td><td valign="middle" style="padding: 1.41pt 2.83pt; border: 0.28pt solid rgb(0, 0, 0); border-image: none; width: 108.93pt; height: 17.65pt;" colspan="2">   </td><td valign="middle" style="border-width: 0.28pt 1.7pt 0.28pt 0.28pt; border-style: solid; border-color: rgb(0, 0, 0); padding: 1.41pt 2.83pt; width: 49px; height: 17.65pt;">   </td></tr><tr><td valign="middle" style="border-width: 0.28pt 0.28pt 1.7pt 1.7pt; border-style: solid; border-color: rgb(0, 0, 0); padding: 1.41pt 2.83pt; width: 117.42pt; height: 17.65pt;" colspan="2">   </td><td valign="middle" style="border-width: 0.28pt 0.28pt 1.7pt; border-style: solid; border-color: rgb(0, 0, 0); padding: 1.41pt 2.83pt; width: 41.01pt; height: 17.65pt;">   </td><td valign="middle" style="border-width: 0.28pt 0.28pt 1.7pt; border-style: solid; border-color: rgb(0, 0, 0); padding: 1.41pt 2.83pt; width: 134.4pt; height: 17.65pt;" colspan="2">년 월 일 ～ 년 월 일</td><td valign="middle" style="border-width: 0.28pt 0.28pt 1.7pt; border-style: solid; border-color: rgb(0, 0, 0); padding: 1.41pt 2.83pt; width: 108.93pt; height: 17.65pt;" colspan="2">   </td><td valign="middle" style="border-width: 0.28pt 1.7pt 1.7pt 0.28pt; border-style: solid; border-color: rgb(0, 0, 0); padding: 1.41pt 2.83pt; width: 49px; height: 17.65pt;">   </td></tr></tbody></table><table width="693" style="width: 693px; border-right-color: rgb(0, 0, 0); border-bottom-color: rgb(0, 0, 0); border-left-color: rgb(0, 0, 0); border-right-width: 0.28pt; border-bottom-width: 0.28pt; border-left-width: 0.28pt; border-right-style: solid; border-bottom-style: solid; border-left-style: solid; border-collapse: collapse; mso-table-overlap: never;"><tbody><tr><td valign="middle" style="padding: 1.41pt 5.1pt; border: currentColor; border-image: none; width: 693px; height: 61.62pt;">본 사실확인서는 <span style="background: rgb(255, 255, 255); color: rgb(0, 0, 0); letter-spacing: -0.6pt; font-family: Verdana,sans-serif; font-size: 14pt; mso-font-width: 90%; mso-text-raise: 0pt; mso-ascii-font-family: 휴먼명조;">(자격명 <span style="background: rgb(255, 255, 255); color: rgb(0, 0, 0); letter-spacing: -0.6pt; font-family: Verdana,sans-serif; font-size: 14pt; mso-font-width: 90%; mso-text-raise: 0pt; mso-ascii-font-family: 휴먼명조;">: ) 국가자격시험에 필요한 경력입증임을 인지하고 이 증명이 허위<span style="background: rgb(255, 255, 255); color: rgb(0, 0, 0); letter-spacing: -0.7pt; font-family: Verdana,sans-serif; font-size: 14pt; mso-font-width: 90%; mso-text-raise: 0pt; mso-ascii-font-family: 휴먼명조;">, 위조 등 사실과 다를 때에는 형사처벌<span style="background: rgb(255, 255, 255); color: rgb(0, 0, 0); letter-spacing: -0.7pt; font-family: Verdana,sans-serif; font-size: 12pt; mso-font-width: 90%; mso-text-raise: 0pt; mso-ascii-font-family: 휴먼명조;">(공<span style="background: rgb(255, 255, 255); color: rgb(0, 0, 0); letter-spacing: -0.7pt; font-family: Verdana,sans-serif; font-size: 12pt; mso-fareast-font-family: 휴먼명조; mso-hansi-font-family: 휴먼명조; mso-font-width: 90%; mso-text-raise: 0pt;">․사문서위조<span style="background: rgb(255, 255, 255); color: rgb(0, 0, 0); letter-spacing: -0.3pt; font-family: Verdana,sans-serif; font-size: 12pt; mso-font-width: 90%; mso-text-raise: 0pt; mso-ascii-font-family: 휴먼명조;">, 변조 등<span style="background: rgb(255, 255, 255); color: rgb(0, 0, 0); letter-spacing: -0.3pt; font-family: Verdana,sans-serif; font-size: 12pt; mso-font-width: 90%; mso-text-raise: 0pt; mso-ascii-font-family: 휴먼명조;">)도 감수하겠음을 명심하고 아래와 같이 입증합니다<span style="background: rgb(255, 255, 255); color: rgb(0, 0, 0); letter-spacing: -0.3pt; font-family: Verdana,sans-serif; font-size: 14pt; mso-font-width: 90%; mso-text-raise: 0pt; mso-ascii-font-family: 휴먼명조;">.</td></tr></tbody></table>   <table width="690" style="width: 690px; border-right-color: rgb(0, 0, 0); border-bottom-color: rgb(0, 0, 0); border-left-color: rgb(0, 0, 0); border-right-width: 0.28pt; border-bottom-width: 0.28pt; border-left-width: 0.28pt; border-right-style: solid; border-bottom-style: solid; border-left-style: solid; border-collapse: collapse; mso-table-overlap: never;"><tbody><tr><td valign="middle" style="background: rgb(214, 214, 214); border-width: 1.7pt 0.28pt 0.28pt 1.7pt; border-style: solid; border-color: rgb(0, 0, 0); padding: 1.41pt 2.83pt; width: 90.17pt; height: 17.65pt;">입증인 성명</td><td valign="middle" style="border-width: 1.7pt medium 0.28pt 0.28pt; border-style: solid none solid solid; border-color: rgb(0, 0, 0) currentColor rgb(0, 0, 0) rgb(0, 0, 0); padding: 1.41pt 2.83pt; width: 137.06pt; height: 17.65pt;" colspan="3">   </td><td valign="middle" style="border-width: 1.7pt 0.28pt 0.28pt medium; border-style: solid solid solid none; border-color: rgb(0, 0, 0) rgb(0, 0, 0) rgb(0, 0, 0) currentColor; padding: 1.41pt 2.83pt; width: 29.53pt; height: 17.65pt;">(인)</td><td valign="middle" style="background: rgb(214, 214, 214); border-width: 1.7pt 0.28pt 0.28pt; border-style: solid; border-color: rgb(0, 0, 0); padding: 1.41pt 2.83pt; width: 94.73pt; height: 17.65pt;" colspan="3">주민등록번호</td><td valign="middle" style="border-width: 1.7pt 1.7pt 0.28pt 0.28pt; border-style: solid; border-color: rgb(0, 0, 0); padding: 1.41pt 2.83pt; width: 166px; height: 17.65pt;">   </td></tr><tr><td valign="middle" style="background: rgb(214, 214, 214); border-width: 0.28pt 0.28pt 0.28pt 1.7pt; border-style: solid; border-color: rgb(0, 0, 0); padding: 1.41pt 2.83pt; width: 90.17pt; height: 17.65pt;">연락처(휴대전화)</td><td valign="middle" style="padding: 1.41pt 2.83pt; border: 0.28pt solid rgb(0, 0, 0); border-image: none; width: 166.59pt; height: 17.65pt;" colspan="4">   </td><td valign="middle" style="background: rgb(214, 214, 214); padding: 1.41pt 2.83pt; border: 0.28pt solid rgb(0, 0, 0); border-image: none; width: 94.73pt; height: 17.65pt;" colspan="3">본인과의 관계</td><td valign="middle" style="border-width: 0.28pt 1.7pt 0.28pt 0.28pt; border-style: solid; border-color: rgb(0, 0, 0); padding: 1.41pt 2.83pt; width: 166px; height: 17.65pt;">   </td></tr><tr><td valign="middle" style="background: rgb(214, 214, 214); border-width: 0.28pt 0.28pt 0.28pt 1.7pt; border-style: solid; border-color: rgb(0, 0, 0); padding: 1.41pt 2.83pt; width: 90.17pt; height: 17.65pt;">주소</td><td valign="middle" style="border-width: 0.28pt 1.7pt 0.28pt 0.28pt; border-style: solid; border-color: rgb(0, 0, 0); padding: 1.41pt 2.83pt; width: 559px; height: 17.65pt;" colspan="8">   </td></tr><tr><td valign="middle" style="background: rgb(214, 214, 214); border-width: 0.28pt 0.28pt 1.7pt 1.7pt; border-style: solid; border-color: rgb(0, 0, 0); padding: 1.41pt 2.83pt; width: 90.17pt; height: 18.82pt;">근무처</td><td valign="middle" style="border-width: 0.28pt 0.28pt 1.7pt; border-style: solid; border-color: rgb(0, 0, 0); padding: 1.41pt 2.83pt; width: 97.97pt; height: 18.82pt;">   </td><td valign="middle" style="background: rgb(214, 214, 214); border-width: 0.28pt 0.28pt 1.7pt; border-style: solid; border-color: rgb(0, 0, 0); padding: 1.41pt 2.83pt; width: 28.98pt; height: 18.82pt;">직위</td><td valign="middle" style="border-width: 0.28pt 0.28pt 1.7pt; border-style: solid; border-color: rgb(0, 0, 0); padding: 1.41pt 2.83pt; width: 55.86pt; height: 18.82pt;" colspan="3">   </td><td valign="middle" style="background: rgb(214, 214, 214); border-width: 0.28pt 0.28pt 1.7pt; border-style: solid; border-color: rgb(0, 0, 0); padding: 1.41pt 2.83pt; width: 55.59pt; height: 18.82pt;">근무처 전화번호</td><td valign="middle" style="border-width: 0.28pt 1.7pt 1.7pt 0.28pt; border-style: solid; border-color: rgb(0, 0, 0); padding: 1.41pt 2.83pt; width: 213px; height: 18.82pt;" colspan="2">   </td></tr></tbody></table><table width="687" style="width: 687px; border-right-color: rgb(0, 0, 0); border-bottom-color: rgb(0, 0, 0); border-left-color: rgb(0, 0, 0); border-right-width: 0.28pt; border-bottom-width: 0.28pt; border-left-width: 0.28pt; border-right-style: solid; border-bottom-style: solid; border-left-style: solid; border-collapse: collapse; mso-table-overlap: never;"><tbody><tr><td valign="middle" style="padding: 1.41pt 5.1pt; border: currentColor; border-image: none; width: 687px; height: 49.02pt;"><span style="background: rgb(255, 255, 255); letter-spacing: -0.5pt; font-size: 11pt; font-weight: bold; mso-fareast-font-family: 휴먼명조; mso-hansi-font-family: 휴먼명조; mso-font-width: 90%; mso-text-raise: 0pt;">※ 입증인 : 객관적으로 수험자의 경력을 입증할 수 있는 자(동일 사업장 또는 직종에서 근무하는 자 등)<span style="background: rgb(255, 255, 255); letter-spacing: -0.5pt; font-size: 11pt; font-weight: bold; mso-fareast-font-family: 휴먼명조; mso-hansi-font-family: 휴먼명조; mso-font-width: 90%; mso-text-raise: 0pt;">    ※ 위 사실확인서의 진위확인과정에서 자료보완 등을 위해 추가서류(입증인의 인감증명서, 공증확인 등)를 요구할 수 있으며, 경력확인불가<span style="background: rgb(255, 255, 255); letter-spacing: -1.7pt; font-size: 11pt; font-weight: bold; mso-fareast-font-family: 휴먼명조; mso-hansi-font-family: 휴먼명조; mso-font-width: 90%; mso-text-raise: 0pt;">ㆍ허위작성 등이 발견되면 반려되거나 관련법에 의거하여 고발조치 될 수 있음</td></tr></tbody></table>   첨 부 : 입증인의 신분증 사본 1부. 끝.   <table width="685" style="width: 685px; border-right-color: rgb(0, 0, 0); border-bottom-color: rgb(0, 0, 0); border-left-color: rgb(0, 0, 0); border-right-width: 0.28pt; border-bottom-width: 0.28pt; border-left-width: 0.28pt; border-right-style: solid; border-bottom-style: solid; border-left-style: solid; border-collapse: collapse; mso-table-overlap: never;"><tbody><tr><td valign="middle" style="background: rgb(214, 214, 214); border-width: 1.7pt 1.7pt 0.28pt; border-style: solid; border-color: rgb(0, 0, 0); padding: 1.41pt 2.83pt; width: 683px; height: 18.22pt;" colspan="2">사실 확인서 입증인의 개인정보 수집·이용에 관한 동의</td></tr><tr><td valign="middle" style="background: rgb(214, 214, 214); border-width: 0.28pt 0.28pt 0.28pt 1.7pt; border-style: solid; border-color: rgb(0, 0, 0); padding: 1.41pt 2.83pt; width: 90.17pt; height: 18.22pt;">수집목적</td><td valign="middle" style="border-width: 0.28pt 1.7pt 0.28pt 0.28pt; border-style: solid; border-color: rgb(0, 0, 0); padding: 1.41pt 2.83pt; width: 555px; height: 18.22pt;"> 국가기술자격법 시행규칙 제14조에 따른 응시자격의 증명</td></tr><tr><td valign="middle" style="background: rgb(214, 214, 214); border-width: 0.28pt 0.28pt 0.28pt 1.7pt; border-style: solid; border-color: rgb(0, 0, 0); padding: 1.41pt 2.83pt; width: 90.17pt; height: 18.22pt;">수집근거</td><td valign="middle" style="border-width: 0.28pt 1.7pt 0.28pt 0.28pt; border-style: solid; border-color: rgb(0, 0, 0); padding: 1.41pt 2.83pt; width: 555px; height: 18.22pt;"> 국가기술자격법 시행령 제33의2(고유식별정보의 처리)</td></tr><tr><td valign="middle" style="background: rgb(214, 214, 214); border-width: 0.28pt 0.28pt 0.28pt 1.7pt; border-style: solid; border-color: rgb(0, 0, 0); padding: 1.41pt 2.83pt; width: 90.17pt; height: 18.22pt;">수집항목</td><td valign="middle" style="border-width: 0.28pt 1.7pt 0.28pt 0.28pt; border-style: solid; border-color: rgb(0, 0, 0); padding: 1.41pt 2.83pt; width: 555px; height: 18.22pt;"> 성명, 주민등록번호, 주소, 전화번호, 근무처, 직위</td></tr><tr><td valign="middle" style="background: rgb(214, 214, 214); border-width: 0.28pt 0.28pt 1.7pt 1.7pt; border-style: solid; border-color: rgb(0, 0, 0); padding: 1.41pt 2.83pt; width: 90.17pt; height: 18.22pt;">이용기간</td><td valign="middle" style="border-width: 0.28pt 1.7pt 1.7pt 0.28pt; border-style: solid; border-color: rgb(0, 0, 0); padding: 1.41pt 2.83pt; width: 555px; height: 18.22pt;"> 수집일로부터 3년간</td></tr></tbody></table><table width="683" style="width: 683px; border-right-color: rgb(0, 0, 0); border-bottom-color: rgb(0, 0, 0); border-left-color: rgb(0, 0, 0); border-right-width: 0.28pt; border-bottom-width: 0.28pt; border-left-width: 0.28pt; border-right-style: solid; border-bottom-style: solid; border-left-style: solid; border-collapse: collapse; mso-table-overlap: never;"><tbody><tr><td valign="middle" style="padding: 1.41pt 5.1pt; border: currentColor; border-image: none; width: 683px; height: 31.42pt;"><span style="background: rgb(255, 255, 255); letter-spacing: -0.5pt; font-size: 11pt; font-weight: bold; mso-fareast-font-family: 휴먼명조; mso-hansi-font-family: 휴먼명조; mso-font-width: 90%; mso-text-raise: 0pt;">   ※ 입증인은 개인정보의 수집·이용을 거부할 수 있습니다. 다만, 개인정보의 수집·이용 등에 동의하지 않을 경우 수험자의 경력사항이 입증되지 않아 응시자격서류심사가 거부 될 수 있습니다. </td></tr></tbody></table> <table width="685" style="width: 685px; border-right-color: rgb(0, 0, 0); border-bottom-color: rgb(0, 0, 0); border-left-color: rgb(0, 0, 0); border-right-width: 0.28pt; border-bottom-width: 0.28pt; border-left-width: 0.28pt; border-right-style: solid; border-bottom-style: solid; border-left-style: solid; border-collapse: collapse; mso-table-overlap: never;"><tbody><tr><td valign="middle" style="padding: 1.41pt 5.1pt; border: 0.28pt dotted rgb(0, 0, 0); border-image: none; width: 685px; height: 18.48pt;" colspan="2">위 개인정보 수집 및 이용에 동의하십니까?</td></tr><tr><td valign="middle" style="padding: 1.41pt 5.1pt; border: 0.28pt dotted rgb(0, 0, 0); border-image: none; width: 190pt; height: 18.48pt;"> □ 동의 함</td><td valign="middle" style="padding: 1.41pt 5.1pt; border: 0.28pt dotted rgb(0, 0, 0); border-image: none; width: 417px; height: 18.48pt;"> □ 동의하지 않음</td></tr></tbody></table>     한국산업인력공단 이 사 장 귀하