CALL NO. 2/2015 FOR APPLICATIONS FOR A POST-DOC RESEARCH FELLOWSHIP DEADLINE FOR APPLICATIONS: midday, January 29, 2015 APPLICATION FORM FOR PARTICIPATION To the Director of the CIMeC I, THE UNDERSIGNED, Surname (women please state maiden name) Name province(1) Place of birth date of birth(2) (foreign nationals please also state the country) Tax code residing in (town and county/state) (house number and street) Province (1) post code country if other than Italy Phone number email address agree to the processing of my personal data, in accordance with Leg. Decree no.196 of 30 th June 2003, for the purposes of the present selection procedure. attach a photocopy (3) of my identity card or other identity document which I will submit in person to the examination offices (obligatory in case an interview is foreseen, and the application is sent by post or delivered by a third party) regarding publication of the results of the selection on the CIMeC website I, the undersigned, (4) : agree to my name appearing do not agree to my name appearing Place and Date __________________________ Signature _________________________ Reserved for office use CIMeC administration I declare that ___________________________________________, whose identity I have confirmed, (document ______________________ no. _______________________) has signed in my presence. Trento, date:___________________ Employee’s name: _____________________________ I, THE UNDERSIGNED, having read the Call for applications no. 2/2015 for the award based on qualifications of 1 postdoc research fellowship at CIMeC, in respect of: Scientific/disciplinary area Principal Investigator (Tutor): Research title: Research goals: Duration of the fellowship: M-PSI/02 Prof. Giorgio Vallortigara Use of NIRS methods to investigate recognition and detection of animacy in human newborns. The research is part of a large project funded by an ERC Grant. Biological predispositions to detect and attend to the characteristics of living things is of pervasive importance for organisms. However, such predispositions are little studied and understood in terms of their neural bases. This is spite of the fact that predispositions to attend to living things may be crucial for normal and abnormal development even in the young of our own species. In this part of the project the post doc will be involved in studies that make use of NIRS methodologies to investigate the neural bases of animacy recognition in human newborn. 12 months (presumably from February 2015) REQUEST permission to apply for the above-mentioned fellowship, and to this end, aware that false declarations are punishable by law under Article 76 of Presidential Decree no. 445 of 28th December 2000 and that this Administration will carry out random checks on the accuracy of the declarations made by candidates, DECLARE under my own responsibility and in accordance with Articles 46-47 of Presidential Decree 445/2000, that I hold the following PhD awarded by date (2) title of thesis OR that I have completed all requirements for the Ph.D. in title of thesis and that I’ll obtain my PhD title prior to signing the contract; that I have appropriate scientific and professional experience required to carry out the research described in article 1 of the call; that I have excellent experience (documented by at least one publication in a peer-reviewed journal) on the topics related to the call (i.e. Nirs methods); that I have an advanced English language skills; that I am aware of the restrictions described in Article 7 of the Call for applications for this research fellowship; The following three points are to be filled out solely by those candidates who have had research assignment contracts with Italian academic institutions since 2011: that I have never received a research award as per Article 22, Law 240/2010; that I have previously received research awards as per Article 22, Law 240/2010 and, in particular, I have been the recipient of1: an award for the duration of _____ months at (name of institution) ____________________, beginning ____________ ending ____________ ; an award for the duration of _____ months at (name of institution) ____________________, beginning ____________ ending ____________ ; an award for the duration of _____ months at (name of institution) ____________________, beginning ____________ ending ____________ ; that I have received a research award as per Article 2, Law 240/2010 for the purposes of undertaking a research doctorate, and in particular: that I was enrolled on a doctoral research course in __________________________________ ____________________ from ________ to __________ at (name of institution) __________________________________, that the legal duration of the doctoral research course in ______________________________ ____________________ is __________ years, that I have made use of an award for ___________ months for the purposes of following a doctoral research course that I am not under any similar contract for research activities at this or any other university; that I do not enter into any of the following exclusion categories, being aware that under Article22, Law 240/2010, the research fellowship: cannot be held by any permanent staff of universities, institutions and public bodies engaged in research and experimentation, the National Agency for New Technologies, Energy and Sustainable Economic Development (ENEA) and the Italian Space Agency (ASI), nor of institutions which award an advanced specialised scientific degree equivalent to a research doctorate under the terms of Article 74, paragraph 4, of Presidential Decree 382/1980; cannot be undertaken at the same time as a course of study for a bachelor’s degree, a master’s degree, grant-supported doctoral research or medical specialisation, in Italy or abroad, and that public sector employees must take unpaid leave; cannot be held by relatives, up to the fourth degree, of faculty members of the awarding institution, the Rector, the Director General or a member of the University Administrative Council; cannot be combined with other grants of any kind, with the exception of those awarded by national or foreign institutions for the purposes of integrating the researcher’s activities with work experience abroad; that I wish correspondence relating to the selection to be sent to me at the following address and that I will give due notice of any change of address. (5) 1 Indicate the number of months for which the award was used and the name of the institution granting the award, e.g. University of Trento; please provide details of each award, for example, if you have had two awards of 24 months each at the same institution indicate these as two separate awards on two different lines. (town and county/state) (house number and street) post code Province (1) country if other than Italy other name (if different from applicant’s own name) to which correspondence may be addressed only for non-EU citizens or citizens from countries which do not have a freedom of movement agreement with the EU that your immigration and visa (permesso di soggiorno) papers are current for (state reason here)…………………… expiring on……………………….; such a visa is an autonomous working permit which allows the possibility to sign freelance work contracts. Should the current visa permit be for reasons other than autonomous work, to undertake to require its conversion to a work permit (lavoro autonomo). Or (only for those who do not have a current visa permit – permesso di soggiorno) to undertake, if winner of the selection, to require a self-employment entry visa. To be attached to this form: Scientific/professional CV (signed and dated) providing evidence of possession of the skills required to carry out the research; Any publications, certificates or other qualifications that may provide further evidence of the candidate’s suitability for this research project (a list of qualifications and publications, signed and dated, must be included with this application); Doctoral degree certificate (or official University confirmation of having met PhD requirements); Photocopy of a valid identity document. Date ___________________ Signature ___________________________________ _________________________ NOTES: This form must be completed in BLOCK CAPITALS (1) Enter the vehicle registration code of the province; for foreign countries enter EE (2) Enter the date in the format DD MM YY (3) Tick if submitting in person (4) Tick the relevant box (5) Complete only if different from residential address. Self-certification model I, THE UNDERSIGNED, ____________________________ Aware of the criminal punishments used in the case of false declarations, the creation or use of false deeds, recalled in article 76 of the Presidential Decree n. 445 of 28th December 2000, as well as the relinquishment of the benefits received on the basis of false declarations, where checks carried out show the non-truthfulness of the content of each declaration (article 75 of Presidential Decree n. 445 of 28th December 2000,) DECLARE UNDER MY OWN RESPONSIBILITY and in accordance with Articles 46-47 of Presidential Decree no. 445 of 28th December 2000 (“selfexecuted certificate and self-executed affidavit”) (Add Curriculum Vitae in this box – do not attach separately) Date __________________________ Signature ________________________________ List of documents and publications I, THE UNDERSIGNED, ____________________________________ aware that false declarations are punishable by law under Article 76 of Presidential Decree no. 445 of 28th December 2000, and that this Administration will carry out random checks on the accuracy of the declarations made by candidates ATTACH THE DOCUMENTS AND PUBLICATIONS LISTED BELOW AND DECLARE THAT THE ATTACHED DOCUMENTS ARE TRUE COPIES OF THE ORIGINALS (in accordance with Article 19 Presidential Decree no. 445, 28th December 2000). 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. Date __________________________ Signature _______________________________ NOTE: Continue on an extra sheet if necessary, attached it and indicate that you have done so in the above list.