Schooling, Educational, Professional And/Or Career History

Please note: This is an unofficial translation provided for your convenience only and does not have any legal binding effects! Only the german version is legally binding!

PERSONNEL DATA SHEET

Personal Information

(Please tick or fill out where applicable) Name, (if applicable maiden name and names from previous marriages), first names (underline name used)

Date of Place of birth Address/District Country Nationality birth

Single Married Living in seperation Divorced

Widowed First and last name of any children: Date of birth:

Primary residence (if applicable, state additional Telephone: places of residence):

E-mail:

Schooling, educational, professional and/or career history (please submit certified diplomas and certificates of employment) a.) School, vocational school, college, university education

Type of school From To Type of diploma/examination (DD.MM.Y (DD.MM.Y Y) Y) 2 b.) Vocational training

Type of vocational training From To Type of diploma/examination (DD.MM.Y (DD.MM.Y Y) Y)

Previous professional or vocational employment including professional or vocational training programs (in chronological order, please also state employment outside of civil service, periods without employment as well as periods as a student assistant or research assistant)

from – to Employer, Type of Weekly/monthl Reason for the (DD.MM.YY Department/Place employment, if y work hours change ) applicable, pay group

Other information

Do you have a severe disability, is your earning capacity reduced or do you have a status equivalent to that of a severely disabled person? no yes (Please attach a certified photocopy of your severe disability identity card or of your notification of equal status issued by your local state- run Employment Office (Agentur für Arbeit)) In the past two years, have you suffered from any serious or chronic diseases that made you unable to work and that might affect your ability to practice your profession (without this having any causal connection to your pre-existing, recognized disability)?

no yes If you answer yes to this question, you will be required to undergo a medical examination by the doctor of the University's health service."

Additional information concerning personnel employed for scientific research with limited-term contracts

1. Private-service contracts contracts with university faculty members who perform services in research and teaching on a service-contract basis)

2. Official acceptende a doctoral candidate (DD.MM.YY) (attach official acknowledgement)

Doctoral degree awarded on**: (DD.MM.YY)

3. Information concerning scholarships and other grants including mention of the purpose of the grant.

I ensure that the information I have provided is correct and complete. I am aware of the fact that incorrect and/or incomplete information can result in immediate termination and/or impugnment of my contract of employment.

Place, date Signature Compensation Package Information Jan./2014 Last name, first name: (Include name given at birth and names from previous marriages)

Date of birth: Place of birth:

Marital status: Nationality: Confession:

Primary residence: Secondary residence: phone: email:

A children’s allowance is being claimed for the following children 1) born on: 3) born on:

2) born on: 4) born on:

Children’s allowance recipient: Previous payer of the children’s allowance: Children’s allowance No.:/File No.: Name of the bank/savings institution: IBAN: BIC: (you find these details on your bank statements)

Name of the health insurance carrier: be on will be given later (Please furnish certification of membership). Social security number: (Enclose a copy of your social security ID card) Recipient of pension or pension benefits: Yes No

Type of pension/pension benefits and payer: Have you paid insurance into the Pension Institution of the German Federal Government and Federal States (VBL1) or similar agencies/institutions as part of previous employment contracts? Yes No Agency/institution: VBL insurance policy no.: Have you had your contributions reimbursed by the obligatory insurance at the VBL (Versorgungsanstalt des Bundes und der Länder - Federal and State Government Employees Retirement Fund) or similar institutions: Yes No

Are you concurrently employed elsewhere No Yes (Please enclose proof) The working contract ended on the: Tax identification number:

Are you concurrently employed elsewhere No Yes (Please enclose proof)

1 Versorgungsanstalt des Bundes und der Länder, VBL (Federal and State Government Employees‘ Retirement Fund) Should employment at the University of Göttingen count as main employment in terms of taxes? Yes No

If you have been employed previously during the current calendar year: The expression of the electronic certificate of income tax Income tax Internal compensation is attached. I certify that the information I have provided is complete and accurate. I understand that I am obligated to report any changes in the circumstances described above to the Personnel Department, Central Administration of the University, Goßlerstr. 5/7, 37073 Göttingen, without delay. ………………………………………………… ……………………………………… Göttingen, (Date) (Signature) Checklist of Personal Records to be Submitted by New Hires:

 Personnel data sheet (Can be downloaded from the website: https://intern.uni-goettingen.de/services/Seiten/default.aspx - Please select your employee group)  Information regarding your compensation package  (can be downloaded from the Internet at: https://intern.uni-goettingen.de/services/Seiten/default.aspx - Please select your employee group)  Certified photocopies of - Birth certificate - If applicable marriage certificate - If applicable birth certificate(n) of the child/of any children  Certified photocopies of the certificates/transcripts (e.g. school-leaving certificate/qualification for university entrance, vocational training certificate, diploma, doctoral degree awarded, post-doc, etc.)  Certified photocopies of proof of previous employment (e.g. certificates of employment, work slips, references)  Certificate of university enrolment (in the case of students or doctoral candidates)  Criminal record (F type O evidence (“Führungszeugnis”)), to be applied for at the competent Residents' registration office of the place of residence listing the hiring agency (address, see above)  Foreign employees should submit a work permit (not for research fellows), and residency permit  Tax Identification Number  Copy of the social security ID card  If applicable, certification of a membership contract with a health insurance carrier  Application for employer-sponsored capital-forming payments (if desired))

Note: If the certificates are written in another language, please attach a certified translation into German.

The adjusting facilities or the personnel department can carry out certifications.