Application Form a Format

APPLICATION FORM – A FORMAT

ADVISE OF PUBLIC SELECTION BASED ON QUALIFICATIONS FOR NO. 1 GRANT IN THE FIELD OF “NUMERICAL MODELING OFPOST-LAST GLACIAL MAXIMUM DEGLACIATION OF A MARINE-BASED PALEO-ICE CAP”BY THE SCIENTIFIC RESEARCH DIVISION - OCE

(General Director Decree n. 334 dd. 07/11/2016)

Deadline 08th December 2016

The undersigned

Surname ………………………………………………………………………………………………………………………………………………

Name …………………………………………………………………………………………………………………………………………………..

born in ……………………………………………………………………………………..…………………………………………………………

foreign citizens should also give the Country of birth……………………………………………………………………………

on the……………………………………………………………………………………………………………………..(day/month/year)

resident in (town, street and number) ………………………………………post code…………………………………………

Province ……… foreign country if applicable ………………………………………………………………………………………..

Nationality …………………………………………………………………………………………………………………………………………….

CF/tax code …………………………………………………………………………………………………………………………………………..

Tel. /ph. Number…………………………………………….email …………………………………………………………………………..

Videoconference account……………………………………………………….….videoconference interview YES / NO

REQUEST

to participate in the selection and, for this purpose, aware that false declarations are punished penally pursuant to art. 76 of the Presidential Decree n. 455 of 28 December 2000, and that the OGS Administration will carry out checks, including random checks, on the truthfulness of the declarations made by the candidates

DECLARES

Under his/her own responsibility, in accordance with arts. 46-47 of DPR 445/2000 (please mark the points owned) :

□ to have a degree in:

………………………………………………………………………………………………………………………………………………………………

□ PhD title in

………………………………………………………………………………………………………………………………………………………………

awarded

………………………………………………………………………………………………………………………………………………………………

title of thesis

………………………………………………………………………………………………………………………………………………………………

□ to be in possession of all requirements indicating in art. 2 of the selection call and to be aware of all the foreseen limitations and not to fall into any of the incompatibility categories outlined in art. 7 of this Selection Call;

□ to have a professional-scientific CV demonstrating skills and ability to conduct the study program. The CV has to correspond to the facts;

□ to attach:

- professional – scientific curriculum vitae (the CV must be undersigned)

- list of the scientific publications

- list of additional certificate or any other qualification that helps demonstrate their merit

(the list of qualifications and publications must be signed by the applicant);

- Short description of the research project – Line D4

□ a copy of ID card or other form of identification;

□ to wish to receive the information, not published on website of OGS, at the following address

………………………………………………………………………………………………………………………………………………………………

Place and dateSignature

……………………………………………………………….……………………………………………………………….

DECLARES

Under his/her own responsibility, that the attached documents are in accordance with arts. 46-47 of DPR 445/2000

The undersigned ask that all documentation elapsed law terms being:
□returnedviapostal mailon deliveryto the holder;
□ returneddirectlyto the personwho willpersonallycollect itwithin sixmonths after the conclusionof the selection (course in vainthat period, thedocuments will bedestroyedanyway);
□destroyed

Place and dateSignature

……………………………………………………………….……………………………………………………………….

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