Application Form
(on plain paper)
To the Head of Department of
Economics and Policies
University of Valle d’Aosta - Université de la Vallée d’Aoste
Strada Cappuccini, 2/A
11100 AOSTA
The undersigned _________________________________________________________________
request
admission to the public selection, on the basis of research project and qualifications,
UNIVDA/SEP/03/2013 for awarding of a research fellowship in the Scientific Area: 13/D4
“mathematic for economics, actuarial sciences and finance”, called according to University
regulation on research fellowships and art. 22 Italian law December 30TH, 2010, # 240.
The undersigned, aware of the liability, including criminal liability, arising from untruthful
declarations, pursuant to the Presidential Decree 445/2000,
DECLARES
1.
Family Name ______________________________________________________________
Name ____________________________________________________________________
Gender:
I____I
(M
or
F)
Italian Social Security Number (for Italian citizens) ________________________________
Citizenship ________________________________________________________________
2.
Born in ______________________________________________ Country. _____________
Date of Birth I___I___I I___I___I I___I___I___I___I (dd mm yy)
3.
Resident in: city _______________________________ Country. ____________________
Address_______________________________________ P.O.________________________
Phone ____________________________________________________________________
4.
Address used for the purposes of this application:
City _____________________________________ Country _________________________
Address __________________________________ P.O. ____________________________
Phone ____________________________________________________________________
E-mail __________________________________ @ ______________________________
undertaking to communicate any subsequent variations and recognising that the
administration accepts no liability in the event of the addressee being untraceable.
5.
To be physically fit for the post
6.
have / have not* criminal convictions (* Delete what is not applicable);
(please list below any sentences passed, even if has been granted amnesty or pardon, and
any ongoing criminal prosecution:
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
7.
to hold the qualification of PhD in _____________________________________________
obtained on ______________________________ (dd/mm/yy)
at the University of __________________________________________________________
8.
to be in the following position in respect of military obligations (to be reported only if
applicable): ________________________________________________________________
9.
di usufruire o aver usufruito della borsa di studio per dottorato di ricerca per anni ____ /
____mesi (indicare il numero di anni o mesi in cui è stata usufruita la borsa di dottorato)
10.
to be in receipt of or to have received a PhD grant for ____ years / ____months (indicate for
how many years or months the PhD grant was received);
11.
to have/have not received previous research fellowship grants from Universities or research
bodies, awarded in accordance with art. 22 of law no. 240/2010, for____ years _____
months at _________ (if so, indicate the number of months/years relative to previous
research fellowship grants and the expiry date of the last contract);
12.
to have/have not held contracts awarded under art. 24 of law no. 240/2010 for ____ years
_____ months at _________ (if so, indicate the number of months/years of the previous
research fellowship grants and the expiry date of the last contract);
13.
to be in possession of a residence permit for _________ with expiry ________(for non-EU
citizens already residing in Italy);
14.
he/she is aware that awarding of the research fellowship is not compatible with the positions
indicated in art. 3 (paragraph 4) of the call for applications, without prejudice to the
provisions of the Regulations for awarding of the university research fellowships and the
current laws:
a. that he/she is not a permanent employee of the Universities, public research
institutions and bodies, the National Council for New Technology, Energy and the
Environment (ENEA) and the Italian Space Agency (ASI), institutions whose
scientific specialisation diploma has been recognised equivalent to the title of PhD in
accordance with article 74, fourth paragraph, of the DPR of 11th July 1980, no. 382,
in accordance with the relative budget availability;
b. that he/she has no kinship or affinity, up to and including the fourth degree, with any
professor belonging to the Department or to the facility announcing the call for
applications, or with the RECTOR, the Director-General or a member of the
University Board of Directors
ENCLOSES







athe applicant’s scientific-professional curriculum, signed in original copy, containing, in
addition to the educational qualification possessed for the purposes of access to the
selection, a detailed description of his/her scientific-professional qualifications with, at the
foot of the curriculum, the declaration pursuant to the DPR 445/2000 and subsequent
amendments and additions that the declarations contained in it correspond to the truth and
authorisation for processing of personal information for the purposes of this selection
procedure pursuant to the d.lgs. 196/2003;
a list of any scientific publications;
research project in Italian or English according to the form provided;
no less than two presentation letters;
copy of a valid ID or Passport;
reprints of the publications with a self-executed affidavit in the form attached to this
announcement to confirm reprints are copies of the original publications
a self-executed affidavit of any academic qualification he/she wants to be evaluated for the
present application
only for candidates holding a degree obtained abroad (see art. 3 paragraph 2 of the
announcement):

Official Italian translation of Ph.D. Diploma, legalized by the authorities of the country
issuing the Diploma if needed, with declaration of value;

(alternatively) a copy of a request for equivalence or equivalence of qualifications obtained
abroad.
The undersigned undertakes to communicate any subsequent variations of postal address, contact
phone number and e-mail, and recognises that the administration accepts no liability in the event of
the addressee being untraceable. Communications must be done by registered letter or certified email.
The undersigned declares, finally, to have read the competition notice and accept all the conditions
laid down therein.
Place and date____________
Signature ___________________________________