APPLICATION FORM

International Criminal Law Defence Seminar

18 – 22 April 2016

Application Deadline: 3 April 2016

Please complete all the information required below, do not omit any information

Your application cannot be processed unless it is complete

Please fill in this application form in word-format or using block capitals

A. Personal Information (as indicated in your passport)
1. Surname/Family Name
/ First Name / Other names
2. Date of birth (dd/mm/yy)
// / 3. Place of birth / 4. Nationality at birth / 5. Present nationality / 6. Gender
Male Female
7. Permanent address
Home Telephone (+ country/area code):
Mobile phone (+ country/area code):
Fax (+ country/area code):
E-mail (it will be used to communicate the selection results):
Skype-id: / 8. Present address (if different from permanent address)
Home Telephone (+ country/area code):
Mobile phone (+ country/area code):
Fax (+ country/area code):
9. Person to notify in case of emergency
Name:
Address:
Telephone no (+ country/area code):
E-mail:

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International Criminal Law Defence Seminar. 2016 Edition

B. Language Proficiency
10. Knowledge of languages
What is your mother tongue?
READ / WRITE / SPEAK / UNDERSTAND
Other languages / Easily / Not Easily / Easily / Not Easily / Easily / Not Easily / Easily / Not Easily
11. As to your English language proficiency, you declare that:
English is my mother tongue
I hold a first or higher degree from an institution in which English is the primary language
I hold an official English certificate (please attach a copy to the application form):
CAMBRIDGE TOEFL IELTS OTHER
Date (dd/mm/yy): // Score obtained:
I do not have any English certificates but I certify that I have the appropriate English language skills that allow me to successfully attend the Seminar.

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International Criminal Law Defence Seminar. 2016 Edition

C. EDUCATION
Give full details, please list in reverse order.
In Column C, please give exact titles of degrees in original language.
In Column D and E, please translate titles of degrees and final dissertation in English (if necessary).
12. University or equivalent
A / B / C / D / E
Name, place and country / Attended from/to / Degrees and academic distinctions
(in original language) / Degrees and academic distinctions
(in English) / Final grade and Title of final dissertation
(in English)
mm/yy / mm/yy
/ / /
/ / /
/ / /
/ / /
13. Specialized courses or other formal training (i.e. technical school or apprenticeship)
Name, place and country / Type
(in English) / Attended from/to / Certificates or diplomas obtained
(in English)
mm/yy / mm/yy
/ / /
/ / /
/ / /
/ / /
14. List professional societies of which you are a member and activities in civic, public or international affaires
15. List any significant publications you have written (DO NOT ATTACH)

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International Criminal Law Defence Seminar. 2016 Edition

D. PROFESSIONAL EXPERIENCE
Please list any relevant present/previous work experiences (internship positions included) in reverse order.
16. Employment record
16.a - PRESENT POST (last post if not presently in employment)
FROM (mm/yy)
/ / TO (mm/yy)
/ / EXACT TITLE OF YOUR POST: / TYPE OF CONTRACT:
Permanent / Temporary / Consultant / Other
EMPLOYER (Name and Address) AND TYPE OF BUSINESS
DESCRIPTION OF YOUR DUTIES
16.b - PREVIOUS POST
FROM (mm/yy)
/ / TO (mm/yy)
/ / EXACT TITLE OF YOUR POST: / TYPE OF CONTRACT:
Permanent / Temporary / Consultant / Other
EMPLOYER (Name and Address) AND TYPE OF BUSINESS
DESCRIPTION OF YOUR DUTIES
16.c - PREVIOUS POST
FROM (mm/yy)
/ / TO (mm/yy)
/ / EXACT TITLE OF YOUR POST: / TYPE OF CONTRACT:
Permanent / Temporary / Consultant / Other
EMPLOYER (Name and Address) AND TYPE OF BUSINESS
DESCRIPTION OF YOUR DUTIES
16.d - PREVIOUS POST
FROM (mm/yy)
/ / TO (mm/yy)
/ / EXACT TITLE OF YOUR POST: / TYPE OF CONTRACT:
Permanent / Temporary / Consultant / Other
EMPLOYER (Name and Address) AND TYPE OF BUSINESS
DESCRIPTION OF YOUR DUTIES
16.e OTHERS (i.e. volunteer experience) and/or additional work experiences
E. ADDITIONAL INFORMATION
17. How did you hear about the Seminar?
You can tick a maximum of three options
UNICRI website
UNICRI emailing
UNICRI Alumni
UIA website or emailing
Turin Bar Association website or emailing
Others (please specify):
18. Are you a member of a Bar Association?
YES NO
If “yes”, please specify:
18.a - Bar Association Country:
18.b - Certificate issued on (mm/yy): /
19. Please state any other relevant information. Include information regarding any residence outside the country of your nationality, disability and/or special need.
20. Scholarship
Do you intend to apply for a scholarship? YES: NO:
In case you were not awarded a scholarship, would you still attend the Seminar? YES: NO:
State the reasons on which your request for scholarship is grounded:
21. Have you ever been arrested, indicted or summoned into court as a defendant in a criminal proceeding, or convicted, fined or imprisoned for the violation of any law (excluding minor traffic violation)?
YES: NO:
If “yes” five full particulars of each case in an attached statement.
F. ACKNOLEDGMENTS AND PRIVACY WAIVER
By ticking this box I certify that the statements made by me in answering the foregoing questions are true, complete and correct to the best of my knowledge and belief.
Date: //
N.B. You may be requested to supply documentary evidence that supports the statements you have made above. Do not, however, send any documentary evidence until you have been asked to do so by the Organization and, in any event, do not submit the original texts of references or testimonials unless they have been obtained for the sole use of applying to the Seminar.
By ticking this box I understand that my data will be processed and protected according to Italian Law n. 196 of June 30, 2003 and to EC Directives n. 95/46 and 2002/58 (protection of persons and others in the processing of personal data). I may at any moment request their updating, verification or cancellation by writing an E-mail to .
Date: //

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