PUBLIC NOTICE FOR THE SELECTION OF N. 1 COMMUNICATION OFFICIER IN THE FRAMEWORK
OF 2007-2013 IPA ADRIATIC CBC PROGRAMME

EXTENSION OF THE DEADLINE

Annex B

APPLICATION FORM

To ABRUZZO SVILUPPO SpA

C.so Vittorio Emanuele II N. 49,

65121 Pescara (Italy)

Public Noticefor the selection of expert in Technical Assistance to 2007-2013 IPA ADRIATIC CBC Programme

The undersigned ______(Family name) ______(First name), Gender _ born on __ / __ / ____ in ______, residing in ______on ______, tax code number ______, telephone number______, E-mail ______

Having examined the notice for the selection of expert in Technical Assistance to 2007-2013 IPA ADRIATIC CBC Programme,

asks

to be admitted to the selection procedure for the following professional profile:

To this end, being the candidate aware of the criminal liability that may be incurred in case of false statements, pursuant to the terms of Articles 46 and 47 of Presidential Decree 445/00, underhis/her own responsibility and unlessanactionforfraud isbrought.

DECLARES

a)to be a citizen of the following State ______;

b)to be registered in the electoral rolls of the Municipality of ______;

in case of non-registration or cancellation from the electoral rolls, please indicate the reasons: ______;

c)to enjoy civil and political rights;

in case of loss of the enjoyment of these rights, please indicate the reasons: ______;

d)to enjoy civil and political rights, also in the country of residence or country of origin (only for Italian citizens);

in case of loss of the enjoyment of these rights, please indicate the reasons: ______;

e)not to be younger than 18 years old and not olderthan the retirement age required by law;

f)to be in compliance with the obligations provided by law on military recruitment with reference to the States where this obligation is still in force;

otherwise please indicate the reasons: ______;

g)that was not dismissed or dispensed from employment in a Public Administration for persistent insufficient performance or fired as a result of disciplinary proceedings, not to have been dismissed from a public employment due to the production of documents that are faked or vitiated by not amendable invalidity;

otherwise please indicate the reasons ______;

h)not to have been retired under Law N.336 of 24 May 1970, and subsequent amendments and integrations, and not to have taken advantage from the retirement according to Presidential Decree N.748 of June 30, 1972 and legislative decree N.165 of 30 March 2001;

i)not to have any criminal record, not to have ever been subject to definitive provisions of security and prevention measures, as well as not to have any previous sentence registered in the criminal code under Article. 686;

otherwise, please indicate any reported criminal convictions, the date and number of the judgment, the authority that issued it, the final provisions on security or prevention measures, even in the case of application of penalty upon request, suspension conditional, non-mention, amnesty, pardon or judicial pardon, and the existence of any previous sentence registered in the criminal code under Article. 686 ______;

j)to have no pending criminal or administrative procedures;

otherwise, please declare any pending criminal and/or administrative proceedings against me before the Italian or foreign judicial authority of any degree: ______;

k)to be in possession of the following qualification/s(education):______pursuedon ______at ______;

in case of possession of a Masters’ degree, the specialtyshall be indicated______;

in the case of a degree pursued abroad, indicate the reference of the provision establishing equivalence ______;

l)that the minimum duration of this curriculum is set in years ______;

m)to possess the specific minimum requirements for participating in the selection as provided byArticle 4 of the notice;

n)in case of award of this work assignment, to be ready to remove contextualconditions of incompatibility as provided by Article 5 of this Notice;

o)to take notice that any discrepancy between the statements declaredwhen submitting this application and the annexed curriculum vitae, and the findings of Abruzzo Sviluppo SpA, subject to the provisions of Art. 76 of Presidential Decree N. 445 of 28th December 2000, will result in the prompt exclusion from the selection procedure.

The undersigned declares to be aware that Abruzzo SviluppoSpAtakes no responsibility in case of loss of communication due to incorrect address details or failure or delayed change of address, or for any postal or telegraphic issue non ascribable to Abruzzo Sviluppo SpA.

The undersigned givestheirconsent to the treatment of their personal data that may be processed in accordance with the Legislative Decree no. 196 of 2003, for all fulfilments related to this procedure.

Annexes:

1)Curriculum vitae in English for the following professional profile Communication Officer, handwritten signature, filled in and made pursuant to and for the effects of the provisions of Presidential Decree 445 of 2000, aware of the consequences in case of false statements;

2)A photocopy of a valid identity document.

______, (date)______

Signature______

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