Fill and Sign the Google and Georgia Medical Board Aprn Registration Forms 2009

FRENCH REPUBLIC IDENTITY PHOTOGRAPH Y LONG-STAY VISA APPLICATION FORM EMBASSY OR CONSULATE STAMP BOX FOR VISA NUMBER STICKER 1. Surname (Family name) ON L This application form is free For official use only 2. Former surname(s) Application date: 3. First name(s) Application number: Nationality at birth, if different: E 7. Current nationality 6. Country of birth 8. Sex Male 5. Place of birth 9. Marital status Single Female Married NC 4. Date of birth (day-month-year) Separated Divorced Processing officer(s): Widow(er) Other (please specify) 10. For minors: Surname, first name, address (if different from applicant's) and nationality of parental authority / legal guardian RE 11. National identity number, where applicable: 12. Type of travel document Diplomatic passport Marginal entries Service passport Official passport Special passport Ordinary passport Other travel document (please specify): ………………………………………………………………………………. 14. Date of issue (DD/MM/YY) FE 13. Number of travel document 15. Valid until (DD/MM/YY) 16. Issued by 17. Applicant's home address (no., street, city, postcode, country) RE 18. Email address 19. Telephone number(s) 20. If you are resident in a country other than the country of current nationality, please state: Number of residence permit 21. Current occupation Date of issue Valid until FO R 22. Employer (employer's address, email and telephone number) - For students, name and address of educational institution OFFICIAL DECISION 23. I request a visa for the following purpose: Date: Employment Studies Family stay Private stay/Visitor Training period/education Marriage Medical reasons Re-entry visa Official taking up of duties Other (please specify): ………………………………………………………… 24. Name, address, email address and telephone number in France of inviting employer / host institution / family member, etc. GRANTED REFUSED Please use the French language 25. What will be your address in France during your stay? form to apply for visa 26. Intended date of entry into France or the Schengen Area Between 3 and 6 months From 6 months to one year Y 27. Intended duration of stay on the territory of France More than one year ON L 28. If you intend to stay in France with members of your family, please state: Surname(s), first name(s) Family relationship Date of birth (DD/MM/YY) 29. What will be your means of support in France? Will you be granted a scholarship? NO E YES Nationality 30. Will you be supported by one or several person(s) in France? NC If yes, write the name, address, email address and telephone number of the institution and the amount of the scholarship: YES NO YES NO YES NO 31. Are members of your family resident in France? RE If yes, state their name, nationality, occupation, email address and telephone number: FE If yes, state their name, nationality, relationship with you, address, email address and telephone number: 32. Have you been resident in France for more than three consecutive months? If yes, specify at which date(s) and for what purpose RE At which address(es)? I am aware of and consent to the following: the collection of the data required by this application form and the taking of my photograph and, if applicable, the taking of fingerprints, are mandatory for the examination of the visa application; and any personal data concerning me which appear on the visa application form, as well as my fingerprints and my photograph will be supplied to the relevant French authorities and processed by those authorities, for the purposes of a decision on my visa application. FO R Such data as well as data concerning the decision taken on my application or a decision whether to annul or revoke a visa issued will be entered into, and stored in the French VISABIO biometric database for a maximum period of five years, during which it will be accessible to the visa authorities and the authorities competent for carrying out checks on visas at borders, national immigration and asylum authorities for the purposes of verifying whether the conditions for the legal entry into, stay and residence on the territory of France are fulfilled, and of identifying persons who do not or who no longer fulfil these conditions. Under certain conditions the data will also be available to designated French authorities and to Europol for the purpose of the prevention, detection and investigation of terrorist offences and of other serious criminal offences. The French authority responsible for processing the data is: [...]. Pursuant to Act No 78-17 of 6 January 1978 on Data Processing, Files and Individual Liberties, I am aware that I have the right to obtain from the French government the communication of the data relating to me recorded in the VISABIO database and the right to request that such data which are inaccurate be corrected or possibly deleted only if processed unlawfully. This right of access to and possible correction of such data shall be exercised by applying to the head of mission or consular post. It may be possible to refer to the National Commission on Data Processing and Liberties (CNIL) if I choose to question the conditions under which the personal data relating to me are protected. I am aware that any incomplete application will increase the risk of my visa application being refused by the consular authority and that the said authority may have to retain my passport while my application is being processed. I declare that to the best of my knowledge all particulars supplied by me are correct and complete. I am aware that any false statements will lead to my application being rejected or to the annulment of a visa already granted and may also render me liable to prosecution under French law. I undertake to leave the French territory before the expiry of the visa, if granted, and if I have been refused the right to stay in France after the expiry of the visa. Please use the French language Place and date Signature (for minors, signature of the parental authority / legal guardian) form to apply for visa