Wojewoda Mazowiecki
WSC-V.8671.7791.787.2014 Date 12
__-__-_____
06 2023
WORK PERMIT type A nr *****/**
for foreigner in Poland
According to Art. 88 Sec. 1 of the Law "On employment and labor market institutions" from 20 April 2004
(2013, 674) and Art. 104 of the Act of June 14, 1960 Administrative Code - (2013, 267).
considering the application of
"_________________"
MISS MAID LIMITED LIABILITY COMPANY,
__-_____
E1 48PX Warsaw, __________________________________________________________________
DOCKLANDS BUSINESS CENTRE SUITE 3C 14 TILLER ROAD CANARY WHARF
(Name / title, address / registered office of the legal entity that provides the application for a work permit for foreigner)
issued a work permit in Poland for
Mr(-rs) __________________________________________
TISSERA WARNAKULASURIYA HIMASHINI
RAVIHARI (Name of foreigner)
Citizen of ________________________________________
SRILANKAN
(Citizenship)
date and place of birth __-__-____,
21 11 1978 __________________
KALPITIYA
(day/month/year/place of birth)
for the position ______________________________________________________________________
HOUSE KEEPING
(position, occupation, responsibilities)
on the basis of (type of contract / time)________________________________________________________
PERMANANT
(the type of the employment relationship with a foreigner)
of gross salary not less than:____________________________________________________________
2800
(rate in Polish currency / period)
Work permit is valid from ____-__-__
202306 17 till ____-__-__
202506 16
EXPLANATION
According to Art. 107 § 4 of the Administrative Code is not substantiated.
NOTES
This authorization entitles to work only on conditions for foreigner’s residence referred in art. 87 P.1 section 12 of the
Law of 20 April 2004 on promoting employment and labour market institutions. In the case of refusal in visa or temporary
residence permit issue, the present document gives no permission to entry, stay and work in the territory of the Republic
of Poland.
The person or legal entity, who applies for a work permit is obliged to forward a copy of it and include in the written
agreement with the foreigner the conditions, including the salary, not worse than in the work permit (art.88, paragraph
1 of the Law of 20 April 2004 on promoting employment and labour market institutions).
In accordance with art. 88i of the Law of 20 April 2004 on promoting employment and labour market institutions, the
person or legal entity, who applies for a work permit for a foreigner is required to notify in written form the Voivodship,
that issued a work permit, within 7 days on the following circumstances:
1) foreigner’s responsibilities or position other than the specified in the work permit, under the conditions in
art.88F, 1b;
2) change the place of residence, name or legal form of the entity who applied for a work permit for a foreigner;
3) change of the work position for another employer;
4) change of the employer representative (art. 88c paragraph 6 p. 3);
5) lack of employment of foreigner within 3 months from the date of issue of the work permit;;
6) termination of work by foreigner for a period exceeding 3 months;
7) termination of work earlier than 3 months before the expiry of the work permit.
Failure to comply the above obligations is punished by a fine of not less than PLN 100 (art.120 p. 6 of the Law).In
accordance with art. 88d of the Act of 20 April 2004 on promoting employment and labour market institutions, obtaining
the work permit does not exempt from certain requirements of the specific fields or activities.
The person or legal entity, who applies for a work permit for a foreigner may submit a request for an extension of the
work permit no earlier than 90 days and no later than 30 days before the expiry of the period of its validity (art.88a, 1A
of the Act).
The decision may be appealed to the proper Minister of work, personally, within 14 days from the date of obtaining the
decision (art.127 § 1 and 2, art.129 § 1 and 2 of the Act of 14 June 1960 - The Administrative Code and art.10 paragraph
2, 3 of the Act of 20 April 2004 on promoting employment and labour market institutions).
The decision in accordance with the request shall be enforced before the expiry of the time for appeal (art.130 § 4 of the
Law of 14 June 1960).
Dimitar Zhivkov Bogdev
____________________________________
(seal and signature of the competent authority)
Confirmation of obtaining a work permit:
(the applicant's signature and date)
06/12/2023
