Participant Application Form THE FORM MUST BE FILLED IN ENGLISH PERSONAL INFORMATION Surname: Date of Birth: Nationality: City: Name: Place of Birth: Address: Post Code: Country: Telephone: Mobile: Email: Sex: Male Female Do you have a driving license? ID Number: Yes No Who should we contact if there is an emergency? Surname: Relationship: City: Name: Address: Country: Post Code: Telephone: Mobile: Email: Your Health Do you have any special dietary needs? Yes No If yes, please tell us about them: Do you have any allergies? Yes No If yes, please tell us about them: Do you have issue in living with pets? Yes No Do you smoke? Yes No Are you taking any regular medication? Yes No If yes, please tell us about them: Are you receiving any medical treatment? Yes No If yes, please tell us about them: Do you suffer of any sleep disorders? (somnambulism, apnea, etc) Yes No If yes, please tell us about them: Have you recently had, or have you ever suffered from any illness or medical conditions? Yes No If yes, please tell us about them: If yes, please tell us about them: YOUR ACCOMMODATION During your stay, you will be responsible for any damage you cause to the property, and will be expected to contribute to the cleanliness and tidiness of your accommodation. Do you understand and agree to this? Yes No During your stay you will be responsible for the safety and security of your own personal possessions, including your money, travel tickets and passport or identity card. Do you understand and agree to this? Yes No WORK EXPERIENCE / INTERNSHIP Which school education / degree do you have? Have you had a vocational training before? Please describe. In which professional field would you like to do the practical training? Please give three concrete examples, in order of preference. 1. 2. 3. Please indicate what concrete tasks you would like to carry out per option. Please give three concrete examples, in order of preference. 1. 2. 3. Which professional experience do you have? Please describe. Have you been abroad for a long time (exchange, practical training, etc.)? Dear participant, Besides the application form you should send the following documents: Europass CV Spanish test Accommodation form Identity card or passport (Scanned copy via email) Motivation letter European Insurance Card (Scanned copy via email) Other possible required documents *Please, take into account that the CV and motivation letter will be sent to the companies. So, it is important you care about the content, style and presentation of those documents. Yes ¿Has tenido antecedentes criminales? Have you ever been convicted of a criminal offence? En caso afirmativo, por favor especifica el motivo. If yes, please, explain the reasons. Herewith I assure that all given details are true (Yo confirmo que la información facilitada es cierta) Signature: Date: No Protección de datos: In order for ONECO-Organización de Educación Comunitaria SLU to provide its services to the client, the client must provide ONECO with the personal data requested. In agreement with that established in Law 15/1999, The Personal Data Protection Act of the 13th December 1999, the user and the bearer of the data are informed, and provide unequivocal consent that in complying with the present agreement, the client’s personal data will automatically be incorporated into the records of ONECOOrganización de Educación Comunitaria SLU in order to offer and provide our services, as well as being able to inform the client of future activities that may be of interest. Equally, the client is informed of the possibility of exercising rights to access, correction, cancellation and opposition to their personal data in the terms established in the decreed legislation, via the e-mail address: leonardo@oneco.org Para que ONECO-Organización de Educación Comunitaria SLU pueda prestar sus servicios al cliente, éste deberá proporcionarnos los datos de carácter personal que se indican. De acuerdo con lo establecido en la ley Orgánica 15/1999, de 13 de Diciembre de 1999, de Protección de Datos de carácter personal, el usuario y titular de los datos queda informado, y presta su consentimiento inequívoco de que mediante la cumplimentación del presente formulario sus datos personales quedarán incorporados a los ficheros automatizados de ONECO-Organización de Educación Comunitaria SLU con el fin de poderle prestar y ofrecer nuestros servicios, así como para informarle de actividades futuras que le puedan ser de interés. Queda igualmente informado sobre la posibilidad de ejercer los derechos de acceso, rectificación, cancelación y oposición de sus datos de carácter personal en los términos establecidos en la legislación vigente, a través de la dirección de correo electrónico: leonardo@oneco.org Signature: Date: