Application Form

To the Director of Management Department
     Ca’ Foscari University of Venice
                                     San Giobbe, Cannaregio 873
                                                                                                                        30121 Venice

The undersigned ___________________________ born in __________________________________ on _______________, Fiscal Code__________________________________ living in ____________________________, in street ____________________n. _____, Postcode _____________, of ____________________________ nationality, tel. __________________ Mobile ______________________, e-mail _______________________________________
Account skype __________________________________________

HEREBY SUBMIT

my application for the public selection for the Short Research Fellowship:

•	Short Research Fellowship: enterprises’ social impact assessment – CUP H19G16000190009 (12 months);

as per procedure announced by Call Ref n. 378/2017 Prot. n. 29254 – III/13 dated 27/06/2017.

I, the undersigned, fully aware of the liabilities, including criminal liability, arising from untruthful declarations, pursuant the Italian Law (D.P.R. 445/2000), hereby declare:

a)	To hold the Master Degree in _____________________ obtained on ___________________________________________ at the University of/other Legal Entity___________________________________________________________;(*)
note (*):Master Degree (or equivalent);
b)	To have:
-	working or teaching experiences;
-	or publications in the following topics:
•	innovation and sustainability;
•	business strategy;
•	corporate social responsibility;
•	financial and accounting analysis;
c)	To be of __________________________ nationality;
d)	To be physically fit for the position;
e)	To know that the short research fellowship’s awarding is not compatible with the positions described in art. 12 of the Regulations about Short Research Fellowships and of the current regulations;
f)	To be in possession of a residence permit/research vsa for ______________________ expiry date on___________ (for non-EU citizens already residing in Italy only); 
g)	To  request the following benefits established by Law no. 104/92 ___________________________________________________________________________________________ and for the above mentioned purpose encloses disability certification;
h)	To use the following address for the purposes of this application:
__________________________________(street) no _________________
At ______________________ Municipality ________________________ POSTCODE ________________
tel.: Land line ____________________________________ Mobile ____________________________
E-mail __________________________________________________________
undertaking to communicate any subsequent variations and recognising that the administration accepts no liability in the event of the addressee being untraceable.

The following documents are enclosed with this application:
a)	the 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, in the footnote of the curriculum, a declaration pursuant to the DPR 445/2000 and subsequent amendments and additions that the contents correspond to the truth, and authorisation for processing of personal information for the purposes of this selection procedure pursuant to the legislative decree 196/2003;
b)	 (a list of any) scientific publications (if required);
c)	declaration of absence of kinship and affinity, up to and including the fourth degree, with any professor belonging to the Department, or with the Dean, the Chief Executive Officer or a member of the University Board of Directors;
d)	any other element required by the call.

Furthermore he/she encloses the following documents:
1. Copy of identity document
2. 										

Date and signature

__________________
ATTESTED AFFIDAVIT
(pursuant the Italian Law D.P.R. 445/2000)
(if compiled by hand, please use capital letters)

I, the undersigned _______________________________, born in ___________________________________ (nationality _________________________), on ___________________(date of birth), passport number/taxpayer’s code __________________________________________ resident in ________________________________________, domiciled in _______________________________________ (street) postcode ___________________ town _______________________________________________

DECLARES

aware that, under the D.P.R. of December the 28th 2000 no. 445, in the event of false declarations I will be subject to the penalties established and will immediately forfeit attribution of the research fellowship grant;
o	that I have no kinship and affinity, up to and including the fourth degree, with any professor belonging to the Department or with the Dean, the Chief Executive Officer or a member of the University Board of Directors;
o	to know that the Short Research Fellowship cannot be combined with: Research Grants; Scholarships, excepting Scholarships granted by National and International Institutions to complete the own Research Program with foreign journey; Dependent Employment – the Short Research Fellowship is compatible with work under an independent contractor agreement. The tutor will certify the compatibility for what concerns self-employment agreements. In any case the Short Research Fellowship is not considered as an employment contract and the Fellow is not part of the University staff. The Fellows cannot be enrolled to Master Degree courses and they cannot be involved in teaching activities.

Furthermore I, the undersigned, undertake to notify any variation with respect to the above declarations that may occur during the period of validity of the contract stipulated with the University, if I am awarded the Short Research Fellowship.

Date _________________	_______________________________________
(Signature)