QUESTIONNAIRE

Questionnaire for new international staff

Dear Sir/Madam,

You have been asked (in the accompanying e-mail) to fill out this questionnaire. Additionally, with this questionnaire we ask you to submit some documents.

We need your information for the following processes:

-to prepare your appointment (if you will be appointed to a salaried position), and/or

-to prepare your file if you will become a PhD or a guest researcher (non-salaried in the Netherlands), and/or

-in order to determine the tax and social security status resulting from your appointment or your personal circumstances, and/or

-in order to prepare your visa application (if you have a non-EU nationality).

In the accompanying e-mail it is mentioned to whom you should send your filled out questionnaire and documents (see checklist at I). We thank you for your cooperation.

*Mandatory for ICT facilities

A Personal information

  1. Given name(s) (in full)fill in name(s)
  2. Preferred namefill in preferred name
  3. Surnamefill in surname
  4. Degree(s)fill in the degrees
  5. Genderchoose gender from list
  6. Date of birthfill in date of birth
  7. Land of birthfill in land of birth
  8. Place of birthfill in place of birth
  9. Nationalityfill in nationality
  10. Native language
  11. Current home address/streetfill in adres/street
  12. Postal code,town, countryfill inpostalcode andtown
  13. Mobile phone number*fill inmobile phone number
  14. E-mail*fill inpersonal email address
  15. Are you going to live (as resident) in the Netherlands?☐Yes☐No
  16. If no: in which country will you have your main residence?fill in country
  17. If yes: what is your (future) Dutch home address
    (if already known)fill in address/street
  18. (Future Dutch) Postal code and townfill in postal code andtown
  19. BSN number (leave blank if unknown)fill in your 9-digit BSN
  20. Dutch IBAN bankaccountnumber (leave blank if yet unknown)fill in IBAN bankaccountnumber

B Marriage/Registered partnership/partnership

  1. Marriage/ Registered partnership/partnershipchoose registration
  2. Given name(s) (in full)fill in name(s)
  3. Surnamefill in surname
  4. Date of marriage/partnershipfill in date

CEmergency contact information

  1. First and Surnamefill in names
  2. Current address /streetfill in adres/street
  3. Postal code and townfill in postal code and town
  4. Telefphone number fill in phone number
  5. E-mailfill in email adres

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DRegistration

  1. Can we mention your contact information on the staff pages of
    our university website?☐Yes☐No
  2. May we list your office details on our University’s website? ☐Yes☐No
  3. Married women are registered under their maiden names. Please indicate how you would like to be addressed by us:

☐Maiden name☐Name partner

☐Maiden name + name partner☐Name partner + maiden name

Section E should only be filled in by non-EU nationals

EVisa Application

Because you have a non-European nationality we need to apply for your residence permit (which also contains the work permit). In order to enter the Netherlands as an immigrant, in most cases we need to apply for a long term visa (MVV).

  1. At which Dutch Embassy or Dutch Consulate General in your country of residence would
    you like to pick up the visa?fill in embassy or DCG
    Information about Dutch embassies can be found on
  2. Please indicate if you wish the University to apply for visa for spouse and/or children☐Yes☐No

FAdditional job

  1. Will you be holding another position (paid or unpaid) besides your (future)
    work for our University?☐Yes☐No
  2. If yes, are you appointed as a professor or a lecturer?☐Yes☐No
  3. Are you appointed as a government official/civil servant in another country?☐Yes☐No

GJob experience

  1. Did you work at the University of Groningen before?☐No☐Yes,my P-number is
  2. Have you been employed in the Netherlands before? ☐No☐Yes
  3. Do you have work experience at another public-sector organization?☐No☐Yes

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Section H should only be completed by PhD students

H Prior university education (highest degree held)

  1. Name of institutionfill in name of institution
  2. Address of university
  3. Postal code, town, country
  4. Faculty
  5. Degree programme
  6. Date of degree
  7. Type of degree

Your PhD Programme at the University of Groningen:

  1. Period of study
  2. Major subject
  3. Project title
  4. Supervisors (“first and second/co-promotores”)
  5. Faculty or Institute at the University of Groningen
  6. Research department at the University of Groningen

I certify that I have read all application instructions and that the information I have provided is true and complete.

I understand that misrepresentation may be a cause for cancellation of my admission or appointment.

I understand that all documents I submit as part of this application become the property of the University of Groningen

(and/or the applicable involved Graduate School of the faculty).

☐I agree

Signature

Name:

Date:

Signature (if signed by hand: please scan the filled in document)

IChecklist

Please mail scans (in PDF) of the following documents together with this questionnaire:

☐Copy of your passport (pages stating personal details and period of validity only)

☐CV with at least the following information: your current home address, e-mail address, marital status

☐Copy of Master or PhD diploma: copy of the original AND a translation by an official translator,

either in Dutch or English (if the original is in another language).

☐For non-EU nationals: signed antecedents certificate (see next page)

Only if you will be appointed to a salaried position:

☐the filled out form “Income Tax”, to be found at :

☐the filled out form “Acknowledgment Additional Activities”, to be found at :

Only if you will be a PhD or guest researcher without salary from the University of Groningen:

☐Proof of sufficient financial means, which can be:

  • As of 1 June 2018 it is no longer sufficient to submit a bank statement showing enough balance. PhDs and guest researchers without salaries or scholarships must transfer the required amount into the University's bank account[1][hier voetnoot] which will be reimbursed after arrival in the Netherlands., or
  • (if rewarded) A grant statement from the University of Groningen. This statement should at least state

the monthly amount for living expenses and the period of the grant (from day/month/year until day/month/year), or

  • (if rewarded) A grant statement from any other scholarship provider. This statement should at least state the

monthly amount for living expenses and the period of the grant (from day/month/year until day/month/year), or

  • a combination of two or more of the options listed above

Please note: you will have to bring those original documents with you to Groningen.

For prospective PhDs (both salaried and non-salaried) you also have to bring the following items:

☐Original Master’s transcript or certified copies

☐English test scores; this is not applicable if you are a native English speaker or obtained your

☐Master’s degree in an English-language programme.

The following documents do not need to be sent to the University of Groningen, but must be arranged in advance

as you will need to present them at the City Hall of Groningen upon arrival:

☐Your original legalized[2] birth certificate(s) and a translation by an official translator, either in Dutch or English


SectionJ should only be filled in by non-EU nationals (visa requirement):

Please note: the signature on the antecedents certificate must be identical to the signature on your passport. If the signatures are not the same the visa application cannot be processed.

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This certificate only needs to be completed if the foreign national is 12 years of age or older. Please note! Not completing this antecedents certificate truthfully is an offense of which in all cases a report will be made..

Appendix

AntecedentsCertificate

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Pleaseticktheapplicable situation

1Certificate

☐Icertifythat:

• Ihaveneverbeensentencedtoimprisonmentoracustodialmeasureforcommittingacrime;

• I haveneverbeensentencedtoperformcommunityserviceforcommittingacrime;

• Ihaveneverbeenimposedanunconditionalfineforcommittingacrime;

• Ihaveneveracceptedanout-of-courtsettlementforcommittingacrime;

• I haveneverbeenimposedapenaltyorderbyapublicprosecutorforcommittingacrime;

• Iamcurrentlynotsubjecttoprosecutionforcommittingacrime;

• IhaveneverbeenresponsibleforoneofthefollowingcategoriesofactsasreferredtoinArticle1Fofthe1951RefugeeConvention:acrimeagainstpeace,awarcrime,acrimeagainsthumanity,aserious non-politicalcrime(forexamplemurderorterrorism),oractscontrarytothepurposesandprinciplesof theUnitedNations(forexampleterroristacts);and

• I amawareofthefactthatasentenceforcommittingacrimemayresultinarefusalortermination

oftherightofresidence.

• Ihavenotsubmittedanyincorrectdataduringearlierresidenceprocedures;

• I didnotresideintheNetherlandsillegallyinthepast;

• Iamnotsubjecttoanyentryban.

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☐ I amunabletocertifytheaboveforthefollowingreasons:

2Signing(bytheforeignnational)

I havecompletedthisformtruthfully.

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2.1Name

2.2Placeanddate

2.3Signature


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Place Day Month Year

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[1]Bank account holder name: Rijksuniversiteit Groningen

Bank: ABN AMRO

Bank account number (IBAN): NL49ABNA0497563215

BIC/SWIFT: ABNANL2A

Bank address: Grote Voort 247, 8041 BL Zwolle, the Netherlands

Payment reference: your full name

[2]Information about legalization/apostille can be found on the website: