Nederlands
English
Maghiar
Polski
Românesc
Registration Form
Personal Data
First Name
Surname
Initials
Gender
-
men
woman
Date of Birth
Birthplace
Nationality
-
Afghan
Albanian
Algerian
American Citizen
American National
Andorrese
Angolan
Argentinian
Australian
Austrian
Bahamian
Bahrain
Barbadian
Belgian
Belizean
Beninese
Bolivian
Botswana
Brazilian
British Citizen
Bruneian
Bulgarian
Burundian
Buthanian
Cambodian
Cameroonian
Canadian
Cape Verdean
Central African
Chadian
Chilean
Chinese
Cirtizen of Bangladesh
Citizan of Tajikistan
Citizan of Timor Leste
Citizan of Trinidad and Tobago
Citizan of Turkmenistan
Citizen of Armenia
Citizen of Azerbaijan
Citizen of Belarus
Citizen of Bosnia and Herzegovina
Citizen of Burkina Faso
Citizen of Croatia
Citizen of Dominica
Citizen of Dominican Republic
Citizen of Georgia
Citizen of India
Citizen of Kazakhstand
Citizen of Kosovo
Citizen of Kyrgyzstan
Citizen of Mauritania
Citizen of Mauritius
Citizen of Moldavia
Citizen of Montenegro
Citizen of Negeria
Citizen of Niger
Citizen of Papua New Guinea
Citizen of Russia
Citizen of Saint Kitts-Nevis
Citizen of Sao Tome and Principe
Citizen of Serbia
Citizen of Sint Vincent and the Grenadines
Citizen of Slovenia
Citizen of the Federal Republic of Germany
Citizen of the Marshall Islands
Citizen of the Ver. Arab Emirates
Citizen of Ukraine
Citizen of Uzbekistan
Colombian
Comorese
Congolese
Costa Rican
Cuban
Cyprus
Czech
Danish
Djiboutian
Dutch
Ecuadorian
Egyptian
Equatorial Guinea
Eritrean
Estonian
Etiopian
Filipino
Finnish
Fjic
French
Gabonese
Gambian
Ghanaian
Greek
Grenadan
Guatemalan
Guinea Bissause
Guinean
Guyanese
Haitian
Honduran
Hungarian
Icelandic
Indonesian
Iranian
Iraqi
Irish
Isreal
Italian
Ivorian
Jamaican
Japanese
Jordanian
Katarese
Kenyaanse
Kiribatic
Kuwaiti
Laotian
Lesothian
Lettish
Libanese
Liberian
Libyan
Liechtenstein
Lithuanian
Luxembourgish
Macedonian
Malagasy
Malawi
Malaysian
Maldivian
Malian
Maltese
Mexican
Monegasque
Mongolian
Moroccan
Mozambican
Myanmarese
Namibian
Nauru
Nepalese
New Zealand
Nicaraguan
North Korean
Norwegian
Omani
Pakistani
Panamanian
Paraguayan
Peruvian
Polish
Portuguese
Romanian
Rwandan
Salvadoran
San Marinese
Saudi Arabian
Senegalese
Seychelles
Sierra Leoonse
Singaporean
Sintlucian
Slovak
Solomon Island
Somali
South African
South Korean
Spanisch
Sri Lankan
Stateless
Sudanese
Surinamese
Swazi
Swedish
Swiss
Syrian
Taiwanese
Tanzanian
Thai
Togolese
Tongan
Tunesian
Turkish
Tuvaluian
Ugandan
Uknown or not Included
Uknown or not Included
Uruguayan
Vanuatuse
Vatican
Venezuelan
Vietnamese
Westamoan
Yemeni
Zairese (Congolese)
Zambian
Zimbabwean
Email
(Mobile) Phone
Marital Status
-
cohabitant
divorced
married
single
Social Security Number
Identification Proof Type
-
Identity card
Passport
Identication Number
Identification Valid Until
Address the Netherlands
Street
House number
Addition
Postal Code
Place of residency
Country
-
Austria
Belgium
Bosnië en Herzegovina
Brazil
Bulgaria
Canada
Cyprus
Czech Republic
Denmark
Estonia
Finland
France
Germany
Greece
Hungary
Indonesia
Iraq
Ireland
Italy
Kroatië
Kuwait
Latvia
Lettish
Lithuania
Luxembourg
Malta
Moldova
Morocco
Netherlands
Noorwegen
Palestina
Poland
Portugal
Romania
Russia
Serbia
Slovakia
Slovakia
Slovenia
South Africa
Spain
Suriname
Sweden
Switserland
Thailand
Tunesian
Tunisia
Turkey
Ukraine
United Kingdom
Venezuela
Verenigde Staten
Vietnam
Address Abroad
Address
House number
Addition
Postal Code
Place of residency
Country
-
Austria
Belgium
Bosnië en Herzegovina
Brazil
Bulgaria
Canada
Cyprus
Czech Republic
Denmark
Estonia
Finland
France
Germany
Greece
Hungary
Indonesia
Iraq
Ireland
Italy
Kroatië
Kuwait
Latvia
Lettish
Lithuania
Luxembourg
Malta
Moldova
Morocco
Netherlands
Noorwegen
Palestina
Poland
Portugal
Romania
Russia
Serbia
Slovakia
Slovakia
Slovenia
South Africa
Spain
Suriname
Sweden
Switserland
Thailand
Tunesian
Tunisia
Turkey
Ukraine
United Kingdom
Venezuela
Verenigde Staten
Vietnam
Command Languages
Dutch
-
Good
Mediocre
Not
Sufficient
English
-
Good
Mediocre
Not
Sufficient
German
-
Good
Mediocre
Not
Sufficient
Driving License
Driving License A
-
No
Yes
Driving License AM
-
No
Yes
Driving License B
-
No
Yes
Validity of Driving License B
Driving License C
-
No
Yes
Driving License D
-
No
Yes
Driving License E
-
No
Yes
Remainder
Reach Truck Certificate
-
No
not applicable
Yes
Forklift Certification
-
No
not applicable
Yes
VCA (Safety/health and environment)
-
No
not applicable
Yes
Welder
-
No
not applicable
Yes
Relevant work experience
Private Transport
Own Transport Type
-
Bicycle
Car
Scooter
Health Insurance
-
Hollandzorg
Private Insurance
Waiver
Social Security Number
Burgerservicenummer
ID/Passport
ID/Paspoort
Other documents (CV/Debit Card/Health Insurance Card/Others)
Overige documenten (CV/Bankpas/Zorgpas/Overige)
The job seeker hereby declares:
That all the requested data have been filled in by the job seeker personally and that this was done voluntarily;
To agree that Uitzendbureau Atik BV in Roosendaal needs this information to offer any temporary work;
To give permission for the processing of his/her personal data by Uitzendbureau Atik BV, for as long as this is necessary to carry out the recruitment process, including the disclosure of this data to potential employers, now and in the future;
To give permission for the disclosure of his/her data in order to be eligible for an offer for temporary employment;
To give permission to Uitzendbureau Atik BV to keep the data for a maximum period of 1 year;
To agree to the right to discontinue the recruitment process en have his/her personal data deleted. This can be done by e-mail to uren@atik.nl;
To give his/her permission to Uitzendbureau Atik BV to send newsletters and information about future vacancies by e-mail.