NASSTEC ESR 2A and 5B application form
Annex II
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SEMILLAS SILVESTRES, S.L.
C/Aulaga nº 24
14012-Cordoba
Spain
Subject: Job advert for a fixed-term contract (CONTRATO TEMPORAL OBRA O SERVICIO DETERMINADO) for one position as NASSTEC Early Stage Researcher in Semillas Silvestres (Cordoba-Spain)
Application form
for ‘NASSTEC’ Early Stage researcher
NASSTEC
The NAtive Seed Science, TEchnology and Conservation Initial Training Network
Contract N. PITN-GA-2013-607785 - 1.4.2014 - 31.3.2018)
FP7 - Marie Curies Initial Training Network
SELF DECLARATION/CERTIFICATION
The undersigned
(Surname) ______
(Married women please specify maiden name)
(Name/s) ______
place of birth ______
country ______date of birth ______
permanent address ______
town / city ______postcode ______
country ______
temporary address (if any) ______
town / city ______postcode ______
country ______
home telephone ______, office telephone ______
mobile telephone ______
e-mail address ______
Address where all correspondence related to the current advert should be sent:
______
______
______
having examined the job advertisement for NASSTEC project manager
S U B M I T S
the following application for this position. Under her/his responsibility s/he:
D E C L A R E S A N D C E R T I F I E S T H A T :
1) / s/he was born in ______country ______on the following date: ______;
2) / her/his nationality is ______;
3) / s/he is physically fit for the position advertised (SEMILAS SILVESTRES is an equal opportunity employer and will promote and facilitate the participation of disabled people);
4) / s/he is registered as a voter for the elections in her/his own country in the following town / city ______country ______; or that s/he is not registered or s/he has been cancelled from the electoral lists for the following reasons:______;
5) / s/he has all civil and political rights in her/his home country
o YES o NO
(delete as appropriate)
or that s/he has been denied all civil and political rights for the following reasons
______;
6) / s/he has pending military obligation:
o YES o NO
(delete as appropriate)
or that s/he has the following military obligations: ______
______
7) / s/he has committed penal crimes, or s/he has convictions or plea bargain or a judicial order about preventive or security measures, or a judicial order written on the criminal records, or has a criminal record,
o YES o NO
(delete as appropriate)
If YES, please provide full details:
______;
8) / s/he has pending penal trials in a court of law:
o YES o NO
(delete as appropriate)
if YES, please provide full details: ______
nature of the crime ______
legal authority where the trial is taking place ______
located in (city) ______country______;
9) / s/he has not been dismissed because of fraudulent documents or having carried out irregular activities at work:
o YES o NO
(delete as appropriate)
10) / s/he is aware that s/he is not eligible for this position if s/he has been dismissed by a public administration within the last 5 years
11) / s/he has been awarded the following first level academic degree: ______
in date ______by the University of ______
address______
with the following final mark: ______and duration ______;
12) / s/he has been awarded the following further post-graduate academic degree/s or other post-graduate professional qualification:
1. ______
in date ______by the University of ______
address______
with the following final mark: ______and duration ______;
2. ______
in date ______by the University of ______
address______
with the following final mark: ______and duration ______;
3. ______
in date ______by the University of ______
address______
with the following final mark: ______and duration ______;
13) / s/he qualifies for a preferential condition/s that will be used to give preference to the applicant in case of equal position in final rank order as specified in annex A of the Job advert:
o YES o NO
(delete as appropriate)
If YES please specify the preferential condition and the employer (if applicable) ______;
(if left blank, the applicant will be considered as not qualifying for any special condition);
14) / s/he belongs to the following special category/ies listed in Act 68/1999 (list of protected categories)
o YES o NO
(delete as appropriate)
If YES please specify the special category/ies you are registered for and the registration authority:______
15) / S/he has a disability listed in art. 3 of local Act 8/2003 or in art. 3 of Act 104/1992 and needs special assistance:
o YES o NO
(delete as appropriate)
If YES specify the disability and the assistance required
______;
(if left blank, the applicant will not benefit of the special assistance granted );
(the applicant must attach – in original or certified copy – a statement issued by the relevant medical authority specifying the handicap and the special assistance needed)
16) / s/he is available to work on any Semillas Silvestres site.
17) / s/he has the following valid driving licence number ______issued by ______, country______, issue date ______expiry date______
S/he is also aware that all the eligibility requirements and qualifications must be held at the closing date of this advert and that s/he is required to inform promptly SEMILLAS SILVESTRES of any variation in the data specified in the application.
S/he is attaching to this application:
- a photocopy of a valid identity document - please specify document type: ______, number ______, issuing authority______,
issuing date ______, expiry date ______;
- the CV (curriculum vitae et studiorum), in the format specified in the following annex III, making sure it includes information on work experience, academic qualifications, proficiency in English and experience in project management;
- N.___ academic reference letters prepared by a former tutor or former employer providing details on the personal skills, abilities and experiences referred to the last 3 years;
- any additional statement required by point 15).
Missing, incomplete, imprecise or partial information will not be considered.
I confirm that the above answered is correct and true.
Location and date ______Signature ______
Please note that to be valid, the application form MUST BE SIGNED by the candidate.
Non-signed applications will not be considered.