Attachment A – Application form (to be completed on plain paper) Director Scuola Normale Superiore Piazza dei Cavalieri, 7 56126 - PISA The undersigned (surname/ name)________________________________________, born in _________________, on (date) __________________ resident in _____________________________ (Province of _________) street _____________ no.___ postal/zip code ________, Italian fiscal code or taxpayer number of country of residence: _____________________ REQUESTS to be admitted to the public competition for the recruitment of one fixed-term researcher, under art. 24, par. 3, lett. a) of the Law 240/2010, engaged on the basis of a full time appointment for a three-year term and by the stipulation of a private-law employment contract, at the Istituto di Scienze Umane e Sociali, to carry out research activities, teaching activities, supplementary teaching activities and tutoring to students, in the academic field 14/C1 “General and Political Sociology, Sociology of Law” – academic discipline SPS/07 “General Sociology” and SPS/11 “Political Sociology”. The undersigned, under his/her responsibility and aware of the legal penalties as indicated in art. 76 of Presidential Decree 445/2000 for false statements DECLARES 1) to have the following citizenship: _____________________ ; 2) |_| to be in possession of a PhD in _____________________________________, awarded on ______________ at the University of _____________________________________ final mark ___________________ and to have carried out at least two years (even nonconsecutive) of post-doc reasearch in Italian or foreign Universities or research institutions, within the indicated subject field, as declared in the curriculum vitae attached to the application; or |_| to have a Master’s degree in ______________ awarded at the University of ________________ on ___________________ final mark ___________________, and to have carried out research activities within the indicated subject field for at least five years after obtaining his/her university degree, as declared in the curriculum vitae attached to the application; 3) (Only for Italian citizens) |_| to be registered in the electoral roll of the municipality of __________________ 1 and to be in compliance with rules regarding military obligations (if subject to); 4) (Only for foreign citizens) |_| to enjoy his/her civil and political rights in his/her Country of residence or origin2 and |_| to have adequate Italian language skills; 5) |_| not to have criminal convictions and to not be currently involved in criminal proceedings or 6) 7) 8) 9) 10) 11) 12) |_| to have the following criminal convictions and/or to be currently involved in the following criminal proceedings: _________________________________________________________________________; 3 not to have been dismissed or retired from a Public Administration body for persistent poor performance; to not have been declared deceased by a state employee under art.127, lett. d) of Presidential Decree 3/1957; not to be employed presently or to have not been employed previously with an open-ended contract as full or associate professor or researcher; not to have any relationships of marriage, family relationships or affinity, up to the fourth degree, with professors belonging to the Istituto di Scienze Umane e Sociali, or with the Director, the Secretary General, the members of the Board of Directors of the Scuola; not to have had fixed-term contracts as research fellow or researcher as provided in Arts. 22 and 24 of Italian Law 240/10 at the Scuola or at other Italian universities, whether public, private or online, or bodies under Par. 1 of Art. 22 of Italian Law 240/10 for a period which, including the intended duration of the current selection, exceeds a total of twelve years, even if not continuing; not to have had fixed-term contracts as researcher as provided in art. 24 par. 3, lett. a) of the Law 240/2010 at the Scuola or at other Italian universities, whether public, private or online, for a period which, including the intended duration of the current selection, exceeds a total of five years, even if not continuing; to be aware of the additional situations of incompatibility under Art. 14 of the Scuola Normale Regulations, as indicated in the art. 8 of the public announcement; |_| to have been recognised as being disabled under Law 104/92 and to need extra-time and/or the following devices for the possible interview: _____________________________________________ . The undersigned attaches the relevant medical certificate, otherwise the benefits shall not be granted. The undersigned ATTACHES the followings to the application form (complying with the “Indications for the presentation of qualifications and publications” under the note B available in the relative section of the website of the Scuola Normale): a) a curriculum vitae containing a detailed list of the qualifications and the complete scientific production4; b) any document and qualification - included among the ones declared in the curriculum vitae under the preceding lett. a) – that the candidate intends to submit, with relative list; c) the publications – included among the ones declared in the curriculum vitae under the preceding lett. a) – that the candidate intends to submit, in the maximum number of 12 including the doctoral thesis5; d) relative list of the aforementioned publications; e) a photocopy (non-authenticated) of a valid identification document. The documents at the previous letters a), b) and d) must be also presented on CD or USB flash drive, in pdf format, while the publications indicated at the letter c) must be presented exclusively on CD or USB flash drive, in pdf format. The undersigned finally DECLARES: - to be aware that all the activities, the scientific and teaching experiences and the qualifications listed in the curriculum vitae attached to the application are to be considered according to and by effect of articles 46 and/or 47 of Presidential Decree 445/2000, and to be aware of the penal consequences in case of untrue statements or falseness in acts, as indicated in art. 76 of the aforementioned Pres. Decree 445/20006. The undersigned also commits himself/herself to submit the documents confirming his/her declarations should it be requested; - to have read the announcement of selection and to be aware that the presentation of this application indicates full acceptance of the conditions specified therein; - to have read the information concerning the use of personal data in accordance with art. 13 Leg. Decree 196/2003, available on the dedicated section of the Scuola’s website, and to be aware that the Scuola Normale will use the personal details contained in the application forms and documents submitted in accordance with Leg. Decree 196/2003, for the completion of all operations connected to the present selection procedure, to the possible employment and for statistical purposes. - to elect the following contact details for the purposes of the selection procedure: At (fill it only if your surname does not appear on the mail box) ___________________________________________ City __________________________________ Street___________________________________ n. ________ Possible foreign State ___________________________ phone/mobile ________________________________ Fax __________________ e-mail ________________________ undertaking to timely communicate any and all changes. Date ________________ 1 Full readable signature7 ___________________ If the applicant is not registered or has been cancelled from the electoral roll, please explicate the reasons. If the applicant does not enjoy his/her civil and political rights, please explicate the reasons. 3 Please indicate the date of the sentence and the judicial authority. 4 Please follow the indications contained in attachment B, par. 1 lett. b of the announcement. 5 If the applicant sends the candidature via PEC- Posta Elettronica Certificata, the presentation of documents and publications on paper, CD or USB flash drive is not requested. 6 The provisions indicated may be applicable to Italian and EU citizens. Concerning the use of the aforementioned provisions by non-EU citizens lawfully residing in Italy or authorized to reside in Italy, please see attachment B of the announcement. Citizens from non-EU States that have not been authorized to reside in Italy should demonstrate the truthfulness of their declarations under their own responsibility, submitting the necessary documents in the required form and by the date specified in the announcement and attachments. 7 The signature is mandatory, in default of which the application shall be void (with the exception of applications sent from candidates who possess an electronic mail address of PEC- Posta Elettronica Certificata). 2