Personal Questionnaire

Company: Takeaway Express

Terms of contract: All forms of ID must be valid for at least 3 months.
This includes: Personal ID, Passport, Work and Residence Permit

Personal Details

Surname

First Name

Severe Disability

YesNo

Severely handicapped passnumber

Degree of disability

Employees with an equivalent disabled status

Place of issue

Date of issue

Department of issue

Date of expiration of severely handicapped pass

Tax information for the application with Takeaway Express

Takeaway Express B.V. & Co. KG is my...

Child information

Number of children

Child 1 name

Child 1 birthdate

Child 2 name

Child 2 birthdate

Child 3 name

Child 3 birthdate

Child 4 name

Child 4 birthdate

Child 5 name

Child 5 birthdate

Please send us the birth certificates of the named children as proof.

Social Insurance

Health Insurance

StatePrivate

Health Insurance Provider (Please give the exact name of the health insurance provider)

Last state insurance company including address

Only for marginal employees (Minijob):

Application for the exemption from the compulsory pension insurance scheme has been obtained.

	Yes	No
Are you currently employed elsewhere?

a. Details of further employment

Time period

Employer

from:

until:

	Type of employment
	Minor employed Major employed Temporarily employed

Weekly working hours

from:

until:

	Type of employment
	Minor employed Major employed Temporarily employed

Weekly working hours

b. Does the combined monthly salary equate to more than 538 EUR?
(Note to the employer: Check social security assessment )

YesNo

Employee Statement: I assure that all the information given above is true to the best of my knowledge. I am obliged to inform my employer of all changes, in particular those regarding further employment (with respect to the type, length and salary).


I have read the privacy policy and agree to the processing of my data:

Terms of contract: All forms of ID must be valid for at least 3 months.
This includes: Personal ID, Passport, Work and Residence Permit