Questionnaire - future work relationship

*please DON’T write all caps when filling in

Name:
Surname:
Gender:
Date of birth (day/month/year):
Nationality:
Passport number:
Passport validity (day/month/year): from…………………………………………; to……………………………………………
Phone number:
E-mail:
Permanent residence address (registered in your passport):

Preferred work position(s) - answer required as well as experience in the position you want to apply for:

Preferred location in the Czech Republic:

a) Prague (exclusively)
b) Prague and cities near Prague
c) any city (without preference)

Preferred salary per month in US dollars:

Highest attained education:

a) elementary
b) secondary (high school)
c) tertiary (university) - undergraduate
d) tertiary (university) - graduate

Put a cross in the check box if you can afford the following visa expanses. Please note that the expanses
differ with every offer, our applicants are usually required to pay for OEC and embassy fee. You need to be
able to afford at least embassy fee in order to be considered candidate for any job offer available.

OEC = $800

embassy fee = 220€

visa agency services for processing your visa = $2230

plane ticket = around $690

Did you live longer than 6 months in a foreign country in the past 3 years ?

a) Yes
b) No

*if you selected yes please specify which country:………………………………………………..; the date of your entry
(day/month/year):…………………………………………..; the date of your departure:…………………………………………