As a supervisor

PERSONAL DATA FORM FOR SUPERVISORS 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     Town and province for which you are responsible:     Number of interviewers co-ordinated     Number of recruiters co-ordinated     I am applying as a supervisor for: Telephone interviews Home interviews In-hall/central location interviews Qualitative/motivational interviews     Availability of own structure: Yes No     Equipment/facilities provided: Meeting room One-way mirror Closed-circuit TV Audio-video recording possible Rooms for carrying out in-hall interviews TV Video recorder Telephone with loudspeaker Other, namely :     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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