Community Plant Variety Office (Angers)

COMMUNITY PLANT VARIETY OFFICE (ANGERS)

APPLICATION FORM

Surname[1]:______Forenames: ______

Address for correspondence[2]:

……………………………………………………………………………………………………………………… No: …………………

Postal code: ………………………… Town: ………………………………Country: ………………………………………….

Telephone No/ ………………………….. E-mail address: ……………………………Fax No:…………………………..

Daytime telephone No: ……………………………………………………………………………………………………………..

Place of birth: ………………………….. Date of birth: Day: ………. Month: …………… Year: ……………………
Nationality: …………………………………………………………………………………………………………………………….
Military Situation (and grade): ………………………………………………………………………………………………….
Knowledge of languages:

Mother tongue or main language: …………………………………………………………………………………………….

Place the following numbers (1, 2, 3 or 4 in the appropriate box or boxes):

1 very good – excellent;

2 good;

3 average;

4 fair.

Language: / Bulgarian / Czech / Danish / Dutch / English / Estonian / Finnish / French / German / Greek / Hungarian / Irish
Oral
Written
Language: / Italian / Latvian / Lithuanian / Maltese / Polish / Portuguese / Romanian / Slovakian / Slovenian / Spanish / Swedish / Other (please specify)
Oral
Written

Education:

A. Primary, secondary, advanced secondary or technical education
Name and address of establishment:
(Town and country) / Period of study / Total length: / Certificate or diploma obtained/ specify date (State main subjects)
From:
(month and year) / To:
(month and year)
B. Higher Education
Name and address of university
or other establishment
(town and country) / Period of study / Total length / Degree or diploma obtained/specify date
(State main subjects)
From
(month and year) / To
(month and year)

8. General, specialist and further training courses:

Name and address of university
or institute
(town and country) / Period of study / Total length / Certificate or diploma obtained/specify date
(State main subjects)
From
(month and year) / To
(month and year)

9. Please provide details of any works published (indicate only those works relevant to the job applied for, and if necessary, please enclose an additional page)

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

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

10. OFFICE SKILLS:

a) Please indicate the various software applications you are currently familiar with:

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

b) Please assess your computer literacy as follows:

beginner normal user expert user

11. Career to date: Please provide details of your professional experience starting with your present post and then the ones you held previously. This part must be completed properly and in detail even if curriculum vitae is enclosed.

1. Present or most recent post / 2. Previous post
Dates / Dates
From
(day/month/year) / To
(day/month/year) / Length
(months) / Field of work: / From
(day/month/year) / To
(day/month/year) / Length
(months) / Field of work:
…../……./………. / …../……./……… / ……… / …../……./……… / …../……./……… / ………
Exact designation and grade of post: / Exact designation and grade of post:
Name and address of employer: / Name and address of employer:
Nature of work: / Nature of work:
3. Earlier posts:
Name and address of employer:
……………………………………………………………………………………………………………………………………………………………………
………………………………………………………………………………………………………. From……./……/……… to ……/……./………..
Length (months): ………………..
Nature of work:
……………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………

Continue on additional sheets if necessary.

12. Period of notice required to leave your present post:

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

13. Long periods spent abroad (please indicate countries visited, dates and reasons for stay):

14. Interests and skills not related to work, including social and sports activities (not compulsory):

15. Name, address and telephone number of a person who can be contacted should you not be available:

16. Short-listed candidates who are invited to come for an interview should provide a criminal record or a similar official document issued in accordance with their respective national law.

1. I declare on my word of honour that the information provided above is true and complete to the best of my knowledge.

2. I further declare on my word of honour that:

(i) I am a national of one of the Member States and exercise my full rights as a citizen;

(ii) I have fulfilled any obligations imposed on me by laws concerning military service;

(iii) I meet the character requirements for the duties involved.

3. I agree to provide supporting documents on request in respect of (i), (ii) and (iii) above and accept that failure to do so may disqualify my application.

Date and signature:

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

(in case of submission by e-mail, the signature is not compulsory)

Important!

Ensure that you sign and date this form and enclose all supporting documents (Letter of Motivation + CV).

You have the right to rectify your data (except merits and skills) for recruitment even after the deadline for submitting your application.

The documents submitted by you to the CPVO will be kept for a period of 24 months from the date of the decision of the Office appointing the successful candidate. The data will then be destroyed.

COMMUNITY PLANT VARIETY OFFICE

ACKNOWLEDGEMENT OF RECEIPT

The Community Plant Variety Office

herewith acknowledges receipt of your application:

(1) Ref. of Post: ______

(2) Date received: ______

(2) Reference Number: ______

(2) For the Community Plant Variety Office (initials) ______

(1)

Name: ______

Address:______

Postal Code/City:______

Country: ______

(1) To be completed by the applicant.

(2) To be completed by the Office.

[1] IMPORTANT: Your application will be registered under this name. Please use it in all correspondence. Any other name (e.g. maiden name) appearing on diplomas or certificates accompanying this application should be indicated below:

[2] The selection board should be informed of any change of address.