PERSONAL QUESTIONNAIRE DIPLOMATIC MISSION  PLEASE ATTACH YOUR PHOTOGRAPH

PERSONAL QUESTIONNAIRE

Diplomatic mission:     

Please attach your photograph here

minimum size

3.5 x 4.5 cm

1) Surname, first name, degree:      

2) Maiden name or other names used now or in the past:      

3) Date and place of birth, birth identification number (if any):      

4) Permanent address, postcode, telephone:
     

Present address, postcode, telephone, e-mail:
     

5) Citizenship:

     

6) Nationality:

     

7) Marital status:

     

8) Highest completed education (school, name, place, year of graduation):

     

9) First name, surname and date of birth of your spouse (if married):      

10) First name, surname and date of birth of your children:      

11) Identity card number, validity:      

12) Passport number, validity:      

13) Driving licence number, validity:      

14) Have you visited the Czech Republic (CSSR, CSFR) before? If so, please give details:

     

15) Have you ever worked in the Czech Republic (CSSR, CSFR)? If so, please give details:

     

16) Has any of your relatives or friends been working or otherwise staying in the Czech Republic? If so, please give details:

     

17) Do you speak Czech? If so, please give details of where you have studied the Czech language and the Czech language skill level:

     

18) Do you have a bank account in the Czech Republic?:

     

19) Do you own a real estate in the Czech Republic?:

     

20) Are you subject to Czech laws and regulations regarding taxation, pensions, social security and medical insurance?:

     

21) Occupations and other activities since the termination of your studies (in chronological order):

22) Have you been employed by a diplomatic mission before? If so, please give details:

     

I, the undersigned declare, that the data I have provided are true and correct. I hereby declare that prior to the completion of this questionnaire, I was duly informed of the processing of my personal data for the purposes of my employment and for the purposes of the security check by the authorities of the Czech Republic.

I agree with the processing of the personal data I have provided by my employer, for the purposes of employment and for the compliance with obligations arising for it from the law, and I therefore undertake to report to it without delay all changes in the personal data given above.

I also agree that my photograph be a part of my personal file.

In       Date       Signature: