Wniosek o odbycie stażu / Application for an internship

WNIOSEK

o odbycie stażu (szkolenia praktycznego), o którym mowa
w art.. 8 ust. 1 pkt 2 ustawy o zmianie ustawy o zawodach lekarza i lekarza dentysty oraz niektórych ustaw (Dz. U. 2020 poz. 1291)


APPLICATION
for an internship (practical training) due to article 8 paragraph 1 point 2 
the Act amending the Act on the professions of doctor and dentist and certain acts

Information clause for graduates of Medical University of Silesia regarding processing personal data

I accept below stated information arising from the information obligation according to Art. 13 of Regulation (EU) 2016/679 of the European Parliament and of the Council of 27 April 2016 on the protection of natural persons with regard to the processing of personal data and on the free movement of such data, and repealing Directive 95/46/EC (General Data Protection Regulation) (Dz. Urz. UE L 119 z 04.05.2016, s. 1), hereinafter referred to as the GDPR:

  1. The Personal Data Controller is Medical University of Silesia in Katowice, 15 Poniatowskiego Street, 40-055 Katowice, tel. 32 208 36 00, NIP: 634-000-53-01, REGON: 000289035;
  2. Current contact details to Data Protection Officer are available under telephone number 32 208 36 00 or on the website www.sum.edu.pl or www.iod.sum.edu.pl.
  3. Your personal data are processed for the purpose of an internship (practice training) and on the grounds of consent given in the field beyond the requirements of the Act, based on Art. 6 item 1 a of GDPR.
  4. Recipients of your personal data will be substantively responsible employees of the Medical University of Silesia in Katowice who are entitled to process personal data and other public authorities, who are required to submit legally justified application for access to personal data.
  5. Medical University of Silesia does not envisage transfer of personal data to a third country.
  6. Personal data will be stored for the period not longer than it is necessary for the purposes in which the data is processed. In justified cases the period is determined by the Rector’s Resolution of the SUM No. 79/2007 of the August 31, 2007 as amended, “Chancellery instruction for the Medical University of Silesia in Katowice”.
  7. You have the right to demand that the Medical University of Silesia give you an access to your personal data, rectify it, delete or limit processing, as well as the right to object to the processing and right to transfer personal data.
  8. You have the right to withdraw consent at any time, without affecting the lawfulness of processing based on consent before its withdrawal.
  9. You have the right to lodge a complaint with a supervisory authority about processing of personal data.
  10. Providing personal data is voluntary. However, the consequence of not providing personal data will lead to preventing registration and participation in internship (pratical training).
  11. Personal data are not the subject of automated decision making.


If the above given information are not fully understandable, you can obtain additional information by contact with the Data Protection Officer, his contact details are available on the website: www.iod.sum.edu.pl and phone number 32 208 36 00.

I hereby declare that above given essence of the information obligation according to the Art. 13 of GDPR is fully comprehensible to me.

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