Please Fill out the Form Legibly in PRINT

JOB APPLICATION FORM

Please fill out the form legibly in PRINT

1.  Given names:

2.  Last name:

3.  Family name:

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4.  Date of birth:

5.  Place of birth:

6.  Registered residence:

Voivodeship, postal code, city, street, building number, apartment number

7.  Residence:

Voivodeship, postal code, city, street, building number, apartment number

8.  ID card number and series:

9.  Expires on:

10.  Permit to work as a driver in the Netherlands: (underline as appropriate) YES NO

11.  Driver’s license number:

12.  Driver’s license expires on:

13.  Polish phone number:

14.  Dutch phone number:

15.  ICE (in case of emergency) phone number

16.  E-mail address:

17.  BSN/SOFI number: (underline as appropriate) YES I DO NOT HAVE ONE

(Numer BSN/SOFI)

18.  Bank account and SWIFT number:

(The bank account number is required in the recruitment process. The candidate must own or co-own a bank account):

19.  Clothing size: (underline as appropriate) S M L XL XXL

20.  Height (in cm):

21.  Shoe size:

22.  Foreign languages:

I.  English (underline as appropriate) Fluent Communicative Basic

II.  German (underline as appropriate) Fluent Communicative Basic

III.  Dutch (underline as appropriate) Fluent Communicative Basic

IV.  (underline as appropriate) Fluent Communicative Basic

23.  Owned residence in the Netherlands: (underline as appropriate) YES NO

24.  Personal insurance in the Netherlands: (underline as appropriate) YES NO

25.  Benefits received in the Netherlands (now): (underline as appropriate) YES NO

26.  Student status: (underline as appropriate) YES NO

27.  International Student Identity Card (ISIC): (underline as appropriate) YES NO

(Numer ISIC)

28.  Resides with parents: (underline as appropriate) YES NO

29.  Professional progress – WORK EXCLUSIVELY IN THE GARDENING SECTOR

Please fill out the table starting with the most recent workplace and make sure to include all years of employment (even if you do not have documents confirming employment in your possession or were self-employed).

Employment time
(from-until) / Position / Company name /
City (country) / Detailed description of tasks and responsibilities
from
until
from
until
from
until

30.  Key professional skills (performed jobs, equipment type, etc.)

31.  Other professional qualifications (licenses, courses, etc.)

32.  Health conditions against physical labour in the Netherlands

(underline as appropriate) YES NO

33.  Time flexibility (from when, for how long, with who):

Additional required application documents (copies):

·  Resume with photo in Polish (alternatively in English)

·  Scan of valid ID card or passport (in colour, both sides)

·  Number of bank account (foreign currency or in the Netherlands)

·  Scan of driver’s license (in colour, both sides)

·  Scan of BSN/SOFI number assignation

Statement of the candidate:

·  I hereby declare that my health allows for employment in the Netherlands to perform physical labour.

·  I hereby declare that I have provided all information in the application voluntarily and am aware that it is required for proper performance of the agreement by the Agency;

·  I have been informed that the requirement of the information in points 1, 2, 3, 4, 5, 13, and 16 results from art. 221 of the Labour Code in association with art. 5 of the Act on the Employment of Temporary Workers dated 9 July 2003 (Journal of Laws no. 166, item 1608);

·  I hereby express consent to the processing of my personal information by For All Seasons Packing sp. z o.o. with its registered seat in Olsztyn at ul. Malewskiego 14/23, 10-686 Olsztyn in scope required for the recruitment process, including current and future sharing with potential employers seated outside of the country (in accordance with the Personal Information Protection Act dated 28 August 1997; Journal of Laws no. 133, item 883);

·  I have been informed that I am entitled to access and change the provided personal information, to information on the purpose and scope of its processing, and to demand that it no longer be processed and removed;

·  I hereby declare that the information in the job application form is true;

·  I hereby express consent to sharing my personal information for purposes of gaining employment;

·  I realise that the Agency does not return the submitted documents (copies) and if the application is rejected the documents are destroyed. I also realise that submission of the form and document translations does not guarantee employment by a foreign employer.

location and date candidate’s signature

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