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REPUBLIKA HRVATSKA MINISTARSTVO UNUTARNJIH POSLOVA REPUBLIC OF CROATIA MINISTRY OF THE INTERIOR OBRAZAC 9a FORM 9a PRIJAMNI PE AT STAMP OF RECEIPT POLICIJSKA UPRAVA POLICE ADMINISTRATION POLICIJSKA POSTAJA POLICE STATION ZAHTJEV / APPLICATION za izdavanje radne dozvole strancu / for issuance of work permit to a foreigner 1. PODACI O POSLODAVCU / INFORMATION ABOUT THE EMPLOYER 1. Naziv poslodavca Name of the employer 2. Sjedi te i adresa Seat and address of the employer 3. Registarski broj u Hrvatskom zavodu za zdravstveno osiguranje Registration number in the Croatian Health Insurance Institute 4. ifra djelatnosti OIB Business activity code 5. Razdoblje za koje se zahtijeva radna dozvola od Period for which the work permit is requested from 6. Naziv radnog mjesta Name of the job position 7. Godi nja kvota DA NE Yearly quota YES NO 8. Sezonsko zapo ljavanje Seasonal employment 9. Dnevna migracija Daily migration do to 2. PODACI O STRANCU / INFORMATION ABOUT THE FOREIGNER 1. Prezime Surname 2. Ime Given name s 3. Ime roditelja Name of the parent 4. Datum ro enja Date of birth 5. Spol M upisuje se ukoliko je dodijeljen / to be entered if issued Sex F 6. Mjesto i dr ava ro enja Place and country of birth 7. Dr avljanstvo Nationality 8. Adresa boravka u Republici Hrvatskoj Residential address in the Republic of Croatia 9. ifra i naziv zanimanja Code and name of occupation 10. Stru na sprema Skill qualifications 11. U radnom odnosu Gainfully employed YES NO 3. VA E A ISPRAVA / VALID DOCUMENT 1. Vrsta isprave Type of document 2. Broj Number 3. Datum izdavanja Issued on 4. Vrijedi do Valid until 5. Nadle no tijelo Competent authority mjesto i datum Place and date Prilozi / Annexes 15269/11 M. PODACI O POSLODAVCU / INFORMATION ABOUT THE EMPLOYER 1. Naziv poslodavca Name of the employer 2. Sjedi te i adresa Seat and address of the employer 3. Registarski broj u Hrvatskom zavodu za zdravstveno osiguranje Registration number in the Croatian Health Insurance Institute 4. Registarski broj u Hrvatskom zavodu za zdravstveno osiguranje Registration number in the Croatian Health Insurance Institute 4. ifra djelatnosti OIB Business activity code 5. Razdoblje za koje se zahtijeva radna dozvola od Period for which the work permit is requested from 6. ifra djelatnosti OIB Business activity code 5. Razdoblje za koje se zahtijeva radna dozvola od Period for which the work permit is requested from 6. Naziv radnog mjesta Name of the job position 7. Godi nja kvota DA NE Yearly quota YES NO 8. Sezonsko zapo ljavanje Seasonal employment 9. Naziv radnog mjesta Name of the job position 7. Godi nja kvota DA NE Yearly quota YES NO 8. Sezonsko zapo ljavanje Seasonal employment 9. Dnevna migracija Daily migration do to 2. PODACI O STRANCU / INFORMATION ABOUT THE FOREIGNER 1. Prezime Surname 2. Dnevna migracija Daily migration do to 2. PODACI O STRANCU / INFORMATION ABOUT THE FOREIGNER 1. Prezime Surname 2. Ime Given name s 3. Ime roditelja Name of the parent 4. Datum ro enja Date of birth 5. Spol M upisuje se ukoliko je dodijeljen / to be entered if issued Sex F 6.

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