APPLICATION FORM – A FORMAT

Istituto Nazionale di Oceanografia e di Geofisica Sperimentale - OGS
Ufficio Protocollo (st. n. 34, 1°piano)
Località Borgo Grotta Gigante, 42/c
34010 Sgonico – TS

ANNOUCEMENT OF PUBLIC SELECTION BASED ON QUALIFICATIONS AND INTERVIEW FOR NO. 1 PROFESSIONALIZING FELLOWSHIP IN THE FIELD OF “CONSTRUCTION OF THE GEOLOGICAL AND TECTONIC MODEL OF THE GULF OF TRIESTE THROUGH THE PROCESSING, TOMOGRAPHIC ANALYSIS AND INTEPRETATION OF THE MULTICHANNEL SEISMIC PROFILES AND MANAGEMENT OF THE GEOLOGICAL INFORMATION IN GIS ENVIRONMENT” BY THE TECHNOLOGICAL RESEARCH DIVISION GEOPHYSIC –GEO.

(General Director Decree n. 321 dd. 28.07.2017)

Deadline 6th september 2017

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);

□ 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 date

………………………………………………………………..

Signature

……………………………………………………………….

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:
□ returned via postal mail on delivery to the holder;
□ returned directly to the person who will personally collect it within six months after the conclusion of the selection (course in vain that period, the documents will be destroyed anyway);
□ destroyed

Place and date Signature

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

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