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Full first name
Full surname
Date of birth
Nationality
Mobile phone number
Email address
What is your current address?
House number
Zip code
In which city do you live?
Are you a student? YesNo
Personal number (BSN)
Type of ID Nederlands PaspoortDutch Identity cardEuropean PassportEuropean Identity cardResidence document (I am allowed to work in the Netherlands)
Expiration date
To ensure that the photo of your ID card meets all requirements, it is important to pay attention to the following points:
No damage or additions
The document must have no cuts, glue residue or other damage.
The passport photo and document must be in good condition.
Validity of the document
Check whether the document is still valid. Expired ID cards are not accepted.
Completeness of the photo
All edges of the document must be visible.
Make sure the passport photo is clear and that no flash obscures visibility.
Additional points of interest:
Always upload a photo of the original document. A copy of a copy is not valid.
It is permitted to place text on the copy, as long as the data on the original document remains legible
ID front
ID back
Money is of course important
What do you want to earn gross per hour?
What is your IBAN number?
IBAN number again to check
Name on your bank card
Apply for a payroll tax credit? YesNoI don't know what that is..
Have you participated in the StiPP pension scheme in the past 52 weeks? NoYes, I participated in the basic regulation in the last 52 weeksYes, I participated in the plus regulation in the last 26 weeksYes, I participated longer than 26 weeks in the plus regulation
How many weeks did your last StiPP scheme last? (if applicable)
Are you receiving benefits now or in the past 3 months? NoYes, Wajong benefitYes, Unemployment benefitsYes, Invalidity benefit (WIA)Yes, Welfare benefitYes, a different benefit
Do you have your own transport? Yes, a carJa, een moped/scooterYes, a bicycleNo, I have to walk
Privacy statement Yes, you may keep my data for 12 months and use it to make me an offer
Do you have any comments of your own?
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