Application Form on Protection and Processing of Personal Data
Dear applicant
This application form has been prepared in order to determine your relationship with our workplace, to determine your personal data processed by our workplace, if any, and to respond to your application correctly and within the legal period.
In order to eliminate legal risks that may arise from unlawful and unfair data sharing and especially to ensure the security of your personal data, our workplace reserves the right to request additional documents and information (copy of identity card or driver's licence etc.) for identification and authorisation. In the event that the information regarding your requests submitted within the scope of the form is not correct and up-to-date or an unauthorised application is made, our workplace does not accept any responsibility for the requests arising from such incorrect information or unauthorised application.
Please fill in the relevant fields by following the instructions below.
- Please fill in the following information about the applicant.
| Name Surname
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| T.C. Identity No
(Passport number or ID number for foreigners) |
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| Telephone No
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| E-mail
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| Address
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- Please indicate your relationship with our workplace.
- Employee
- Visitor
- Patient / Potential patient
- Employee candidate
- Other:
……………………………………………..
- Please indicate your application request.
| Request No | Request Subject | Your choice |
| 1. | I would like to learn whether my personal data is processed by your workplace. [KVK Kanunu m. 11/1 (a)] | ☐ |
| 2. | If my personal data has been processed by your workplace, I request information regarding this. [KVK Kanunu m. 11/1 (b)] | ☐ |
| 3. | I would like to learn the purpose of processing my personal data and whether it is used in accordance with the purpose of processing. [KVK Kanunu m. 11/1 (c)] | ☐ |
| 4. | If my personal data is transferred to third parties in Turkey or abroad, I would like to learn about these third parties. [KVK Kanunu m. 11 /1 (ç)] | ☐ |
| 5. | I believe that my personal data is incomplete or incorrectly processed and I request correction. Please send your petition stating the personal data you want to be corrected and the documents showing the correct and complementary information as an attachment. (Photocopy of identity card, residence, etc.) [KVK Kanunu m. 11 /1 (d)] | ☐ |
| 6. |
I think that the reasons requiring the processing of my personal data have disappeared and within this framework, I request that my personal data;
b) I request anonymisation. [KVK Kanunu m. 11 /1(e)] |
☐ |
| 7. | I would like the third parties to whom my personal data have been transferred to be informed of the actions taken pursuant to my rectification request (Request No. 5). [KVK Kanunu m. 11/1 (f)] | ☐ |
| 8. | I want the third parties to whom my personal data have been transferred to be notified of the actions taken in accordance with my request for deletion or destruction (Request No. 6). [KVK Kanunu m. 11/1 (f)] | ☐ |
| 9. |
I think that my personal data processed by your workplace has been analysed exclusively through automated systems and a result has arisen against me. I object to this result. Please send your petition regarding the result of the analysis you think is against you and the documents supporting your objection as an attachment. [Article 11/1 (g) of the KVK Law] |
☐ |
| 10. |
I have suffered damage due to unlawful processing of my personal data. I request that this damage be compensated.
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☐ |
| Please write if you have any additional comments. |
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- Select the method by which you will be notified of our response to your application.
- I want it to be sent to my address.
I want to receive it from the data controller by hand. (In case of delivery by proxy, a notarised power of attorney or authorisation document must be submitted).
I want a reply to my e-mail address.
- Applicant Declaration
In line with the information, documents and requests I have specified in the application form, I request that my application to the data controller be evaluated in accordance with the provisions of the Law and the Application Communiqué and that I be informed. In this context, I hereby declare and undertake that the information and documents I have provided to you with this application are correct and up-to-date, that your workplace may process my personal data in order to finalise my application, may request additional information and / or documents, and that I have been informed that I may be required to pay the fee determined by the Personal Data Protection Board if it requires an additional cost.
| Name and surname of the applicant | : | |
| Application Date | : | |
| Signature | : |
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