Questionnaire for those interested in an internship

Fill out the questionnaire carefully and attentively, making sure that your contact details are correct.

Have you already done an internship at VFN Prague?*
- Yes
- No
Please enter your full name*
Remember to include titles before and after your name, if you have any.
Please enter your residential address*
Street and house number Municipality/Village Postal code
Please enter your phone number*
Please enter your e-mail address*

Are you sent on internship by your employer?*
- Yes
- No
Fill in your billing information
How will you pay for the internship?*
- Self-payer, I´m not a self-employed person or a healthcare entrepreneur
- I will pay for the internship as a self-employed person or through a company in which I am a partner
Enter a name*
Enter the full address*
ID number*
VAT number*

Enter employer name*
Enter the full address of employer´s registered office*
Enter employer´s ID number*
Enter employer´s VAT number*
Statutory representative of the empoloyer*
This could be e.g. the director. Please provide full name including titles and position.
Will another person sign the contract with us on behalf of the employer's statutory representative?*
- Yes
- No
Who is the representative who will sign the contract?*
Please provide full name including titles and position.
Will your employer pay for the internship?*
- Yes
- No

Where do you have an internship in VFN?*
Please select a workplace or clinic from the list.
I work as*
- doctor, dentist or pharmacist
- non-medical health professional
- other
When does your internship start?*
Date Format: DD slash MM slash YYYY
When does your internship end?*
Date Format: DD slash MM slash YYYY
Who is the supervisor in VFN who will take care of you?*
Please provide your full name, including titles before and after the name.
Do you have a second internship in VFN?*
- Yes
- No
Where do you have your second internship with us?*
Please select a workplace or clinic from the list.
When does your second internship start?*
Date Format: DD slash MM slash YYYY
When does your second internship end?*
Date Format: DD slash MM slash YYYY
Who is the supervisor in VFN who will take care of you?*
Please provide your full name, including titles before and after the name.
Do you have a third internship in VFN?*
- Yes
- No
Where do you have your third internship with us?*
Please select a workplace or clinic from the list.
When does your third internship start?*
Date Format: DD slash MM slash YYYY
When does your third internship end?*
Date Format: DD slash MM slash YYYY
Who is the supervisor in VFN who will take care of you?*
Please provide your full name, including titles before and after the name.
Here is a space for any of your notes and comments on the internships you have arranged.
Please attach a printscreen of the email (or other) communication with the consent of your VFN supervisor or the workplace where you are doing your internship*
You can attach up to 10 printscreens. Upload the files in image format (.jpg, .png, .gif) or .pdf file. The maximum file size is 5MB.
Drop files here or

Accepted file types: jpg, jpeg, gif, png, pdf.
Consent to the processing of personal data*
I agree to the processing of personal data

Dotazníky VFN

Questionnaire for those interested in an internship

Krok 1 z 4 - Information about you

Fill in your billing information