Nouvel embauché

Formulaire d'inscription nouveaux embauchés

 

A compléter en lettres "MAJUSCULES"

 

N° d'agent (4 chiffres)

Service

 

 

 Nom

Prénom

Date de naissance 

{"name":"DateNai","value":"","required":true,"disabled":false,"showTime":false,"rows":1,"cols":1,"title":false,"showDate":true,"preloadCalendar":false,"id":null,"placeholder_date":false,"placeholder_time":false,"size":"","start_id":"","class":"","class-time":"","calendar":{"cols":1,"rows":1,"dateCursor":"pointer"},"valueViewDate":"","valueViewTime":"","formatDate":"d\/m\/Y","formatTime":"H:i","checkDateOnLoad":false,"autocomplete":null}

Lieu de naissance

 

Sexe 

Adresse

Code postal

Ville

  Portable

Email  Professionnel

Email personnel

Situation familiale

Si vous êtes titulaire d'un contrat d'apprentissage, d'un contrat d'alternance ou d'une convention de stage, sélectionnez "CDD" et indiquez la date de fin de votre contrat.

Type de contrat 

Date début de contrat 

{"name":"DateEnt","value":"","required":true,"disabled":false,"showTime":false,"rows":1,"cols":1,"title":false,"showDate":true,"preloadCalendar":false,"id":null,"placeholder_date":false,"placeholder_time":false,"size":"","start_id":"","class":"","class-time":"","calendar":{"cols":1,"rows":1,"dateCursor":"pointer"},"valueViewDate":"","valueViewTime":"","formatDate":"d\/m\/Y","formatTime":"H:i","checkDateOnLoad":false,"autocomplete":null}

Copie du contrat 

Date de fin contrat (CDD uniquement)

{"name":"DateSor","value":"","required":false,"disabled":false,"showTime":false,"rows":1,"cols":1,"title":false,"showDate":true,"preloadCalendar":false,"id":null,"placeholder_date":false,"placeholder_time":false,"size":"","start_id":"","class":"","class-time":"","calendar":{"cols":1,"rows":1,"dateCursor":"pointer"},"valueViewDate":"","valueViewTime":"","formatDate":"d\/m\/Y","formatTime":"H:i","checkDateOnLoad":false,"autocomplete":null}

 

Si votre conjoint, concubin ou partenaire de pacs est salarié(e) de la CARSAT Pays de la Loire, merci d'indiquer son matricule :  

 

Certifié exact,  le  {"name":"Date-jour","value":"","required":true,"disabled":false,"showTime":false,"rows":1,"cols":1,"title":false,"showDate":true,"preloadCalendar":false,"id":null,"placeholder_date":false,"placeholder_time":false,"size":"","start_id":"","class":"","class-time":"","calendar":{"cols":1,"rows":1,"dateCursor":"pointer"},"valueViewDate":"","valueViewTime":"","formatDate":"d\/m\/Y","formatTime":"H:i","checkDateOnLoad":false,"autocomplete":null}