Attachment A – Application form and CV

(on plain paper)

The Director

ScuolaNormaleSuperiore

Piazza deiCavalieri, 7

56126 - PISA

I, the undersigned(surname and name) ______,born in ______on______and resident in ______(Prov. ____) Address______Postcode ______Country ______Fiscal code(Italian citizens only)______

APPLY

for admission to the public selection procedure for the recruitmentof 1 fixed-term full-time researcher, in accordance with art. 24, par. 3, lett. B, of Italian Law 240/2010, in the Faculty of Humanitiesof the ScuolaNormaleSuperiore, for Academic Recruitment Field11/A1 – Medieval History, Academic disciplineM-STO/01 Medieval History

To this end, under my own responsibility, pursuant to art. 46 andart. 47 of Presidential Decree 445/2000 and subsequent amendments,and aware of the legal sanctions under art.76 of the same Presidential Decree in case of false declarations, I hereby

DECLARE

1)|_| to be a citizen of the following EUcountry[1]: ______

OR

|_| to be a citizen of the following non-EU country ______(if needed) with a regular residence permit granted by act No. ______of (date) ______issued by the following authority ______for ______reasons–and expiring on ______

2)that I meet the admission requirementslisted under art.2 of the call, and in particular that:

-I hold a PhD in ______, awarded on ______by the University of ______Final mark: ______

In case of degree awarded abroad, I also declare:

|_| the following references to international agreements or provisions attesting the equivalence with the Italian title “dottore di ricerca” in accordance to art. 74 of Presidential Decree 382/1980, or equivalence in accordance to art.38 of Italian Law 165/2001: ______

OR, in case the above data are missing,

|_| that I am about to request a certification of equivalence with the Italian title “dottore di ricerca” in accordance with art. 74 of Presidential Decree No. 382/1980 OR |_| that I am about to request a certification of equivalence in accordance with art. 38 of Italian Law 165/2001, and that I am aware that I need to submit, under penalty of exclusion, the documentation certifying the equivalence of my title with the Italian title “dottore di ricerca”no later than the recruitment date;

-I meet at least one of the following additional requirements:

|_| a)I have obtained a National Scientific Qualification for the function of ______(Full or Associate)Professor, pursuant to art. 16 of Law 240/2010, for the academic discipline ______,awarded on ______, in the following session ______;

OR

|_| b)I have used for at least three years, even not-consecutive:

|_| contracts of fixed-term researcher according to art.1, par. 14, of Law 230/2005 with the University of ______from _ _ / _ _ / _ _ _ _ to _ _ / _ _ / _ _ _ _;

(please specify the above for every contract)

|_| contracts of fixed-term researcher – Type a,according to art.24, par. 3, lett. A,of Law 240/2010 with the University of ______from _ _ / _ _ / _ _ _ _ to _ _ / _ _ / _ _ _ _;

(please specify the above for every contract)

|_| research grants awarded according toart. 51, par. 6, of Law 449/1997 and subsequent amendmentsby the University of ______from _ _ / _ _ / _ _ _ _ to _ _ / _ _ / _ _ _ _;

(please specify the above for every grant)

|_| research grants awarded according to art. 22 of Law 240/2010by the University of ______from _ _ / _ _ / _ _ _ _to _ _ / _ _ / _ _ _ _;

(please specify the above for every grant)

|_| post-doctoral grants awarded according toart.4 of Law 398/1989by the University of ______from _ _ / _ _ / _ _ _ _ to _ _ / _ _ / _ _ _ _

(please specify the above for every grant)

|_| equivalent contracts, grants or scholarships held in foreign universities and research institutions, and in particular:

______contract/grant/scholarship(please clearly state name and type)at the University of ______from _ _ / _ _ / _ _ _ _ to_ _ / _ _ / _ _ _ _;

(please specify the above for every contract/grant/scholarship)

For the purposes of the maturation of the minimum period of three years, the services provided in the above functions can be combined.

In case of contracts/research grants/post-doctoral grants carried out abroad, Iattach copy of the related contract or the degree/certificate issued by theinstitution as indicated in the art. 2 of Italian call.

3) (Italian citizens only) |_| to be enrolled on the electoral lists of the Comune of ______[2]and to be in compliance with the law as regards military service;

4)(foreign citizens only) |_| to enjoy full civil and political rights in my country of origin or provenance[3]and to have the following level of knowledge of the Italian language: ______;

5)that I have not been dismissed or removedfrom a job within the public administration due to prolonged insufficient performance, and that I have not been revoked from State employment in accordance with art. 127, lett. D, of Presidential Decree DPR 3/1957for having obtained the position supplying false documents or documents vitiated by unrectifiable mistakes, and that I have not been dismissed from a job within the public administration on disciplinary grounds;

6)|_| that I have not been found guilty of any criminal offense and that I am not subject to any ongoing criminal proceedings;OR|_| that I have been found guilty of the following criminal offense and/or I am subject to the following ongoing criminal proceedings:______[4];

7)that I am not currently employed, and I have not been previously employed, as Full or Associate Professor or permanent Researcherin Italian universities or institutes and that I have not been employed in an equivalent position abroad (according to the Tables of Correspondance of the Italian Ministry for Education);

8)to have no kinship or affinity up to the fourth grade and not to be married or have a civil partnershipwith the Director, the General Secretary, a member of the Board of Directors, or a professor of the Faculty of Humanitiesof the ScuolaNormaleSuperiore. I also declarenot to fill any of the previously mentioned positions, and that I was not a professor of the Faculty of Humanitiesor a member of the Board of Directors of the Scuolaat the publication of the recruitment resolution or at any later moment up until the appointment of a fixed-term researcher;

9)not to have heldany contract in the capacity of Research Fellow or fixed-term Researcher, in accordance with art. 22 and art. 24 of Law 240/2010,with the ScuolaNormale or other Italian public, private, or telematic universities, or with bodies under art.22, par. 1, of Law 240/2010,for more than twelve years, even not-consecutive and including the length of the contract offered by the present procedure[5];

10)to be aware of the additional conditions of incompatibility established by art. 14 of the current Regulation of the Scuola and listed in art. 9 of the call for selection;

11)|_| to have a certified disability pursuant to Law 104/92 and to need additional time and/or the following support means for the public discussion: ______. To this end, I attachthe relative medical certificate,under penalty of inapplicability of the above benefits;

12)to have read the text of the call and to be aware that, by filling the present application form, I accept all its conditions and prescriptions;

13)to have read the information on the treatment of personal data under art. 13 of Law 196/2003,available on the website of the ScuolaNormale, and to be aware that the Scuola will process my personal data in accordance with the lawfor the purposes of the present selection procedure, the hiring process and the following work relationship, other than for statistical purposes;

14)that what is stated in the present application form and in the attached CV is true and in accordance with art. 46 and art. 47 of Presidential Decree 445/2000[6],and that I am ready to prove it by submitting the relative documentation on request,in compliance with the terms and conditions established by law;

15)that the copies of the publications submitted on the digital storage device (CD, USB flash drive, etc.) attached to the present application form, in the maximum number of 12 established by the call (including the doctoral thesis, if submitted) and listed in the attached form, are conform to the originals in my possess and have been published as provided by current regulations, with the exception of any work accepted for publication and included in its final form in the storage device. (If needed)For such works, I attach the publisher’s certificate or a self-certification affidavitconfirming that they have been accepted for publication.

16)that for the purpose of the present selection procedure I am available at the following address(the ScuolaNormale will send any communication to this address):

C/o(only if the candidate’s surname is not on the mailbox) ______; Town ______Address ______Postcode ______

Country ______; Phone ______E-mail ______

I will promptly inform the Scuola of any variation.

I ATTACH to the present application form:

a)mycurriculum vitae;

b)copy of a valid personal document;

c)any qualification[7]listed in the CV that I deem relevant for assessment purposes,and/or the relative certifying documents – including copies of the contracts/decrees or certificates issued by institutions attesting contracts/research grants/post-doctoral grants carried out abroad as per art. 2 of the Italian call –in the original form or in a certified copy in conformity with the original[8],with relative list;

d)the signed list of submitted publications, in the maximum number of 12, as established by the call (including the doctoral thesis, if submitted), produced as per attachment;

e)the publications included in the above-mentioned list, in the maximum number of 12, as established by the call. Such publications are submitted exclusivelyon a digital storage device (CD, USB flash driveetc.) in a non-editable format (e.g. pdf)[9][10]. The same storage device also includes a scanned copy of my application form and CV, together with the documents under the previous letters b), c) and d).

Date______Readable Signature[11] ______

CURRICULUM VITAE[12]

(to be attached to the application form)

DR. ______

(NAME AND SURNAME)

I Part – Personal details

Name and Surname
Date of birth
Place of birth
Nationality
Current academic/work position, specifying if it is a tenured/permanent position
Languages spoken

II Part – Academic titles

Title name and type / Achievement date / Institute and Country / Final grade
(if provided) / Thesis title
and notes
Degree in …………
PhD in….
Any other title

etc. (please list any title achieved)

III Part–Other qualifications

III.1 –Teaching activity in Italian or foreign universities:

Dates / Institute and Country / Short description of the teaching activity[13]
from_ _ / _ _ / _ _ _ _ / to _ _ / _ _ / _ _ _ _
from_ _ / _ _ / _ _ _ _ / to _ _ / _ _ / _ _ _ _

etc. (please list any teaching activity)

III.2 –Certified study or research activity in Italian or foreign institutions

Dates / Institute and Country / Short description of the study/research activity[14]
from_ _ / _ _ / _ _ _ _ / to_ _ / _ _ / _ _ __
from_ _ / _ _ / _ _ _ _ / to_ _ / _ _ / _ _ __

etc. (please list any study or research activity)

III.4 –Clinical activities (only for those recruitment fields that require it):

Dates / Institute and Country / Short description of the activity[15]
dal _ _ / _ _ / _ _ _ _ / dal _ _ / _ _ / _ _ _ _

etc. (please list any clinical activity)

III.5 - Projects (only for those recruitment fields that require it):

Dates / Institute and Country / Short description of the activity[16]
from_ _ / _ _ / _ ___ / to _ _ / _ _ / _ _ _ _

etc. (please list any project)

III.4 - Organisation, supervision and coordination of national and international research groups or participation in any research group:

Dates / Research group/programme[17] / Role and short description of the activity[18]
from_ _ / _ _ / __ _ / to _ _ / _ _ / _ _ _ _
from_ _ / _ _ / __ _ / to _ _ / _ _ / _ _ _ _

etc. (please list any research group/programme)

III.5 –Ownership of patents (only for those recruitment fields that require it)[19]:

Title / Description / Submission No. / License No. / Name of the owner / Name of the inventor / Date of submission

etc. (please list any patent)

III.6 –Speeches[20] in national and international conferences and congresses:

Date of the conference/congress / Organising body and place of the conference / Conference/Congress title(please specify if national or international) / Speech title
(please specify if invited speaker)
Date _ _ / _ _ / _ _ _
Date _ _ / _ _ / _ _ _
Date _ _ / _ _ / _ _ _
Date _ _ / _ _ / _ _ _
Date _ _ / _ _ / _ _ _

etc. (please list any speech)

III.7 –National and international awards for research activities:

Date of issue / Name/Title of the award
(please specify if national or international) / Awarding body
and Country / Notes

etc. (please list any research award)

III.8 –European specialisation diplomas recognised by international boards (only for those recruitment fields that require it):

Date / Institute and Country / Short description[21]

etc. (please list any diploma)

III.9 – Any additional title or qualification[22]:

Name of the title or qualification / Dates / Short description
1 - ….
2 - ….
3 - ….

etc. (please list any additional title or qualification)

IV Part – Authored or co-authored scientific publications(entire scientific production)

No. / Type of scientific product
(article, monography, contribution etc.) / Author/s / Publication title
(of the article/contribution/entry…) and its code (ISBN) / Title of the journal/book/dictionary containing the article/contribution/entry and its code
(ISSN-DOI-ISBN) / Year of publication
1 -
2 -
3 -
4 -
5 -
6 -
7 -
8 -
Etc.

1

[1] Italians who do not belong to the Italian Republic should declare any equality with Italian citizens.

[2] Please state any reason for not being enrolled or for having been deleted from an electoral roll.

[3] Please state any reason for not enjoying full civil and political rights.

[4] Please state the proceeding’s date and issuing authority.

[5] In accordance with the current regulations, this period does not include any maternity or sick leave.

[6] For candidates who can make use of self-certification affidavits in accordance with art. 4 of the call for selection.

[7] Please note that those candidates who can make use of self-certification affidavits in accordance with art.4 of the call for selection will prove that they have the necessary qualifications to be submitted for evaluation simply by listing them in their CV, pursuant to art. 46 e 47 of Presidential Decree 445/2000. Therefore, they do not need to attach the originals or any authenticated copy, nor any affidavit attesting the conformity with the originals.

[8] Only for those candidates who can make use of self-certification affidavits pursuant to art. 4 of the call for selection.

[9] In case the application form with relative documentation is sent by a certified e-mail address (PEC), the candidate will not need to submit the hard-copies of the documentation nor the copies on digital storage device.

[10] The Scuola accepts no responsibility in case the files contained in the digital storage device are illegible and cannot therefore be evaluated.

[11] It is mandatory for the application form to be manually signed with an original signature, under penalty of exclusion (with the only exception of the applications sent from a PEC address personally held by the candidate).

[12]The present CV describes in detail the qualification held by the candidate that are deemed relevant for the assessment procedure. The CV is organised following a scheme that can be modified/integrated by the candidate who wishes to adapt it to its own activity.All the space available can be integrated as needed.

[13]Please list in detail all the relevant elements for assessment, e.g.: name of the course or lectures held, total teaching hours, type of course (e.g.: Bachelor’s degree course, PhD course, Master’s degree course, Summer School), type of contract (e.g.: teaching appointment, visiting professor, researcher appointment).

[14]Please list in details all the relevant elements for assessment, e.g.: type of contract or academic position (e.g.:research grant, fixed-term researcher contract, PhD scholarship/grant.), subject, procedures.

[15] Please list in detail all the relevant elements for assessment. If irrelevant, please leave blank.

[16]Please list in detail all the relevant elements for assessment. If irrelevant, please leave blank.

[17]Please state the name of the research group and/or programme, specifying if national or international, the name of any private/public funding body and any call or other relevant detail.

[18]Please list in detail all the relevant elements for assessment, e.g.: any organisation, supervision or coordination role within the research programme (PI-principal investigator, local supervisor, etc.) and any activities.

[19]Please fill every space; in case the candidate does not own any patent, please leave blank.

[20]Please list only speeches as a rapporteur in conferences/congresses. Other participations (posters, simple auditors etc) can be indicated at the following point III.9.

[21]Please list in detail all the relevant elements for assessment, e.g.: scientific field, title of the thesis, final grade. In case the candidate does not hold this kind of diploma, please leave blank.

[22] E.g. participation in editorial committees of scientific journals, supervision or tutoring activities for doctoral theses, participation in organisational committees of conferences/congresses, scientific divulgation activities, participation in selection committees, scientific reviewing activities, organisation of relevant exhibitions, participations in conferences/congresses not as rapporteurs etc.The Selection Committee will decide on the relevance of any additional title/qualification.