Facsimile of application form 

To the Head of the Centre of
______________________________________________
at the University of Padova

The undersigned____________________________________________________________________
born in __________________________________________________________________[insert city, country]  on__________________, resident at _____[insert house number], ________________________________________________________________ [insert street name], ____________ [insert postcode,]  
of _________________________nationality, having telephone no.  _________________________, e-mail _______________________and certified e-mail (PEC): ______________________________

HEREBY REQUESTS
to be admitted to the following selection process for the awarding of a research fellowship, through the evaluation of qualifications  and interview process.
The selection process has been authorised by provision of Ref. no. 41 dated 22 January 2018

If EU citizen hereby declares, aware of criminal liability in the event of false or incomplete statements, pursuant to Italian Presidential Decree 445/2000:
•	to possess the following qualifications:
 _____________________________________________________________________________
•	to be a citizen of  _____________________ 

if Non-EU citizens produces the original titles, a certified copy or a copy declared to be in conformity with the original or use the substitutive declarations according to the procedures provided for the citizens of the European Union, or certification issued by the competent authorities of the foreign State, accompanied by an Italian translation authenticated by the Italian consular authority that attests conformity to the original, with the methods indicated in art. 3 of the D.P.R. 445/2000.

•	declares to have a valid residence permit on the date of the application deadline
In both cases, declares
•	to have read the University's "Regulations Governing Research Fellowships" and to not be in any condition that provides for ineligibility, and has no marriage, family or kinship relationships up to the fourth degree with lecturers or researchers working at the Department elected as "Research Base", or with Rector, or Director General, or  a member of the University Board of Governors 
•	to give their address for the managing of the selection process:
o	Home Address
o	to the following address:
______ [house number], __________________________________________ [street], __________________________________________[city], __________________________________________[country] _______________________________________________ [postcode]

Pursuant to Art. 20 of Law no.104/1992, the applicant requires the following arrangements for interview process ___________________________________________and attaches relevant disability certification.  
Declares to be aware and consents that the data provided in this declaration can be treated in compliance with Legislative Decree no. 196/2003 and subsequent amendments and modifications, for all matters relating to managing of this selection process.

The application shall be accompanied by the following:
a) a CV detailing professional, academic and research background;  
b) copy of an identity document; for Non-EU citizens: valid residence permit
c) any other documentation as indicated in the selection announcement;
d) any other documentation deemed relevant for the evaluation. 

Date__________________________
Applicant's signature
________________________________________________
APPLICATION IS ACCOMPANIED BY FOLLOWING DOCUMENTS:
________________________________________________
________________________________________________
________________________________________________
________________________________________________
________________________________________________

Date__________________________

Applicant's signature
________________________________________________

If the application form is submitted in person or by registered mail, please, report on the envelope:
 
Selection announcement for the awarding of 1 research fellowship entitled: 
Support for the definition of Ganimede's observations for the study of librations