Name  *

First name  *

Street  *

ZIP Code  *

Domicile  *

Personnel-No.  *

Employer  *

Ref / COMAIL  *

Phone No. / Handy  *

Email  *

Introduced by

Employed through  *  GAV (collective labour agreement)   Individual contract / L&H 

Place of work  *  ZRH   BSL   GVA   other 

All information in  *  German   French   English 

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