Name of employee:__Mario Sain__________________________________

In connection with your appointment, the following documents must be presented or the
following must be done:
(If forms are required, please attach them to this form.)

(x) Personnel form with declaration regarding penal convictions and disciplinary measures

(x) Supplementary details to the personnel form- statistics

(x) Curriculum vitae

(x) Copy of valid identity card or passport

(?) Marriage certificate

(?) Child’s birth certificate (application for child benefit at http://www.uni-

kassel.de/intranet/schnelleinstieg/formulare/formulare-bezuegestelle-hessische-hochschulen.html)

(?) Declaration regarding child allowance

(x) Degree certificate (Diplom, Master, Bachelor), doctoral certificate, habilitation certificate,
licensing certificate, transcript of records

( ) Evidence of the individual parts of the qualifying examination in

medicine/dentistry/veterinary medicine

(x) Form “Selbstauskunft für das Elektronische LohnSteuerAbzugsMerkmale-Verfahren”

(ELStAM)

(x) Bank and social security details (please attach)

(x) Copy of social security card

(x) Medical insurance certificate (certificate of membership)

( ) Certificate of pension fund membership

( ) Exemption decision from the Deutsche Rentenversicherung (German statutory pension

insurance scheme) giving you exemption from the obligation to pay employees’ pension
contributions; it may be necessary to apply to the pension fund relevant to you for
exemption. Further information can be obtained from the pension fund of the Hessian State
Chamber of Physicians/Hessian State Chamber of Veterinarians.

( ) Certificate of medical insurance contributions for voluntarily insured persons (Social

Security Code V (SGB V), Article 257)

( ) Customer number Federal Employment Agency (if available)

(x) Description of working procedures signed and returned

(x) The pre-appointment medical examination will take place on

at

The medical examination will be conducted at the Justus Liebig University Medical Office,
MAS GmbH, Memeler Strasse 1/corner of Licher Strasse, 35394 Giessen.

Please hand in the completed health questionnaire to MAS together with – if required –
the form completed in agreement with your line-manager to apply for preventive health
check-ups if you have to handle biological substances, genetically modified organisms,
dangerous chemical substances and ionising radiation in the course of your work.

Remember to take your vaccination card with you to the medical examination.

Important note: It is your contractual obligation to present the “Ärztliche Bescheinigung

über die Einstellungs-/Eignungsuntersuchung zur Vorlage beim Arbeitgeber” (medical
certificate based on the medical examination for appointment/suitability for presentation to
the employer) issued to you by the Medical Office, MAS GmbH, without delay to the Human
Resources Department.

If you are unable to keep your appointment, please call 0641 99-19300 or 0641 4955330
to make another appointment! If no one answers your call, please leave a message so that
the medical centre can call you back.

( ) Application for dangerous substances allowance

(x) Police clearance certificate (document type “O”); please send to:

Justus Liebig University Giessen

Personalmanagement C 3.1
Goethestr. 58
35390 Giessen

(x) Declaration (6.152) signed and returned

(x) Please sign and return acknowledgement of receipt of the following information:

(x) Circular No 31/95

(x) Notes on secondary occupation
(x) Information sheet for federal state employees on the acceptance of financial
rewards and gifts
(x) Circular No 13/1998 of 22 June 1998 (safety at work and environmental
protection)
(x) Fact sheet on registering as seeking employment
(x) Fact sheet on the General Act on Equal Treatment (AGG)
(x) Instructions (excerpt from the general circular decree of the Hessian Ministry of
the Interior (HMI) of 9 July 1979)
(x) Fact sheet on exemption from compulsory insurance with VBL
(x) Statute of Justus Liebig University Giessen for Ensuring Good Academic Practice
(version of 29 May 2002)

For non-German citizens:

(x) Residence permit / certificate of freedom of movement

As on 19 November 2012