As an interviewer

PERSONAL DATA FORM FOR INTERVIEWERS Name Surname Domicile:   Adress Town Province Postal code Residence: if different from domicile Address Town Province Postal code Place of birth Date of birth   gg/mm/aaaa Education qualification Current occupation Telephone Cell-phone Fax E-mail Personal tax code VAT position     I am applying for: Telephone interviews Home interviews In-hall/central location interviews     Times available: 9.00 - 13.00 14.00 - 18.00 18.00 - 22.00     Available to work on Saturday: Yes No     Available to work on Sunday: Yes No     Do you already have experience as an interviewer? Yes No     Additional information:     I hereby authorise the company Sinaptica s.r.l. to use my personal data, in accordance with Italian Law No. 196, of 30 June 2003.

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