Application form
(on unstamped paper)

To the Director of the Department of Environmental Sciences, Informatics and Statistics
Ca’ Foscari University, Venice 
Via Torino, 155
30170 Mestre (VE)

I, the undersigned ___________________________ born in ______________________________ (prov. of ____) on _______________, passport no. / taxpayer’s code no. __________________________________ resident in __________________ (province of _____), in ____________________ (street) no. _____, postcode _____________, nationality ________________, tel. __________________ mobile ______________________,   email ___________________________
hereby submit
my application for the qualification-based public selection process, per procedure announced by call Ref. no. 562/2021, dated 27/04/2021, for the short research fellowship within the scope of the research programme “Explainable Machine Learning Algorithms Implementation”, lasting 4 months”, lasting 4 months, Tutor Prof. Wilmer Pasut. 

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)	 s/he holds the qualification of master degree / PhD / other…..  in _______________ obtained on ___________ at the University of/other Legal Entity________________;
b)	in the event that the candidate does not hold the qualifications specified above, s/he shall be able to demonstrate many years’ experience in:
c)	s/he is of  _____________ nationality [for non-EU citizens already residing in Italy only, ;that s/he  is in possession of a residence permit/research visa for _________ expiry date on________];
d)	s/he e is physically fit for the position; 
e)	to be aware that the awarding of the short term research fellowship is not compatible with the positions referred to in art. 12 of the Regulations for short term research fellowships and the current legislation;
f)	to not have any kinship and affinity, up to and including the fourth degree, with any professor belonging to the Department or to the Centre announcing the call for applications, or with the Rector, the Chief Executive Officer or a member of the University Board of Directors and to be aware of the relevant provisions of Law 240/2010. Article 18, par. 1, lett b);
g)	s/he requests the following benefits established by Law no. 104/92:
.......................................................................................................................................................
and for the above mentioned purpose encloses disability certification;
h)	s/he  uses the following address for the purposes of this application:
………………………………………………………………(street) no……………… at……………………. municipality……………………....... POSTCODE……….. PROV…………………………………………………………………..
tel. …………………..  land line ……………………………  mobile ………………… email  …………………………………… 
undertaking to communicate any subsequent variations and recognising that the administration accepts no liability in the event of the addressee being untraceable.

i) the undersigned gives her/is consent for the personal data provided to be processed, in compliance with Legislative Decree no. 197/2003 and subsequent amendments and modifications, for the requirements related to this selection procedure.

The following are enclosed with this application: 
a)	 a CV detailing professional, academic and research background;
b)	copy of an identity document;
c)	any other element  required by the call;
d)	any other documentation deemed relevant for the evaluation.

Date and signature  

N.B.
The University does not take any responsibility for cases of unavailability of the recipient or for the dispersal of communications resulting from inaccurate indication of domicile or of contact details by the candidate, failure or late communication of contact details’ variation or any other reason not attributable to the University, nor from any error in postal delivery, or in any case from acts attributable to third parties, from unforeseeable circumstances or force majeure.
The declarations made in the application shall be considered made pursuant to the D.P.R. n. 445/2000 and subsequent amendments, by candidates entitled to use the simplified administrative certifications allowed by the aforementioned decree.