Personaldatenblatt Für Externe Lehre

ENGLISH DRAFTING OF Personaldatenblatt/ Personal data record External/ New examiner/supervisor Dienstweg/ Official channels: Eingelangt am/Come in on: Completed back to the Leopold-Franzens-Universität Innsbruck Koordinationsstelle für universitäre Weiterbildung Innrain 52f Universitätslehrgang:*) A-6020 Innsbruck For transmission to Central Administration Eingelangt am/Come in on: *) To be Leopold-Franzens-Universität Innsbruck Important: Please enclose acompleted copy of the passport or Innrain 52 another official document! entifikationsdokument!by the A-6020 Innsbruck Examining Section

1. Statements of personal data (Minimum data to draw up references): Surname: Firstname: Private address - street: Post code - Residence: Date of birth: Social security number:

yes**) Office: Are you subject to a federal employment contract under public law in Austria? no **) The examiner is an active Federal official, that means the remuneration is to be paid as additional occupation payment and it is liable to contribute to social security as well as to pay wage tax.

2. Contact:

E-mail address:

Phone number:

3. Relevant accounting statements: Bank: Code number:

Account number:

Abroad: IBAN/BIC: ***)

SWIFT-Code: ***)

Nationality:

Native country:

Place of birth:

***) To be stated only in case of a foreign bank account.

______Date Signature Examiner/ Supervisor Obligatory enclosures: Copy of passport Completed BIDOK-writing Please complete the form completely, with block letters and well legible!

IMPORTANT: The completed personal data record does not cause any legal claim to payment by the examiner/supervisor. Any remuneration is to be paid according to the guidelines of the Leopold-Franzens- Universität Innsburck, in any case it is a matter of a lump sum payment, which does not substantiate any future legal claim and can be revoked by the employer anytime.

Leopold-Franzens-Universität Innsbruck Central Administration Personnel department Enclosure to Personal data record External/New examiner/supervisor

To the Examiner/ Supervisor

Educational Documentation Law („Bildungsdokumentationsgesetz“)

Dear Examiner/ Supervisor, the Leopold-Franzens-Universtät Innsbruck is obliged to accumulate data for statistical purposes because of the Federal Law about documentation within the education system* („Bildungsdokumentationsgesetz“) and belonging to it the implementing regulation**.

Therefore it is necessary to announce your highest completed education (scholastic or University respectively) according to stipulated definitions. Please make one selection only:

Graduation with doctorate Graduation with diploma Graduation with bachelorhood Diploma of a college of education Other tertiary educational graduation (e.g. course of lectures, examination for the master` s certificate, educational course) School leaving examination of a general secondary school School leaving – and diploma examination of a vocational secondary school Apprenticeship` s final examination, vocational middle school Compulsory education

The notification of a teaching qualification conferred by postdoctoral qualification (venia docendi) -announcing the University and the subject - is required as well:

University: ______Subject:______

First- and Surname (block letters): ______

Social security number: ______

I herewith declare the correctness of my statements

______Signature Examiner/ Supervisor

Thank you very much for your cooperation!

______* BGBl. I Nr. 12/2002 idF ** BGBl. II Nr. 499/2003 idF