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Blankett gäller för samhällsorientering/

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Blankett gäller för samhällsorientering/

Notification of Orientation about Swedish society

Personuppgifter/Personal data

Personnummer(år, månad, dag,nr)

Personal Identity Number (year, month, day, no)

Uppehålls- och arbetstillstånd (år, månad, dag)

Residence Permit (year, month, day)

Efternamn/Surname, family name

Förnamn/First name

Adress/Address c/o address

Postnummer/Area code

Postadress/Postal address

Telefon/mobil/ Phone/mobile

E-postadress/E-mail address

Ankomstår till Sverige/

Year of arrival in Sweden

Natonalitet/Nationality Hemspråk/First language

Övriga språk/Other languages

Kunskap/Knowledge

God/good

Medel/average

Liten/little

1.

Engelska

2.

Svenska

3.

Nuvarande arbete och studier /Current work and education: Ange dag och tid, samt var du arbetar/studerar.

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Blankett gäller för samhällsorientering/

Notification of Orientation about Swedish society

Jag tillhör etableringsreformen:

Ja sedan år och månad: Nej

Jag godkänner att mina personuppgifter registreras av administrationen för vuxenutbildning, enligt The General Data Protection Regulation (GDPR) / I admit that my personal data is registered by the administration of adult learning, according to the european law regarding personal data The General Data Protection Regulation (GDPR) , .

Underskrift/Signature av sökande

Datum/Date

Ort/City

Underskrift/Signature

Skicka till/Send to: Ludvika Kommun Integrationsenheten Carlavägen 24 771 82 Ludvika

Eller e-postadress/Or to following e-mailaddress: integration@ludvika.se

Ansökan mottagen av/Notification received by administratör

Datum/Date

Namn/Name

References

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