ALMA.be - Op zoek naar werk tijdens de schoolperiode

The MMM...eating Place

Looking for part-time work: application form

Please fill out this form as fully and accurately as possible.

Personal details

Last name
First name
Sex	M V
Nationality
Country of birth
City or town of birth
Date of birth	/ / (dd/mm/yyyy)
Belgian registration number	- - (11-digit number at the top of your SIS card)
SIS card number	(lower left-hand corner of your SIS card)
ID card number	- -

Address

Official address (on your ID card)
Street
Number	Box
Postal code
City or town

If you wish to receive your mail at a different address
Street
Number	Box
Postal code
City or town
Telephone
Mobile phone
E-mail

For part-time work

Would you like to work during regular office hours?	hours/week
Would you like to work evenings?	hours/week
Would you like to work weekends?	hours/weekend
Would you like to work	in the kitchen waiter/service staff both
How do you get around?	car motorcycle bicycle public transportation
Would you like to work	in Leuven centre at Gasthuisberg hospital in Heverlee
Please give the number of the bank account where you would like your pay to be deposited	- -

Medical information

Do you have any medical reason for not being able to carry out specific jobs?	yes no
If so, what?

Education

What level of education have you completed?

Secondary school
Post-secondary education

Family information

Civil status	married unmarried co-habiting
Do you have any dependants?	Partner: yes no Your partner's name: Children : yes no
Are you	retired housewife unemployed working full-time
Who should be notified in case of accidents?	(First name and last name)
	Telephone number:

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