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 Classe di Scienze Matematiche e Naturali, to carry out
research activities, teaching activities, supplementary teaching activities and tutoring to students, in the
academic field 03/A2 “Models and methods for chemistry” – academic discipline CHIM/02 “Physical
Chemistry”.
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 ___________________
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 a _________________ knowledge of the Italian language;
5) |_| not to have criminal convictions and to not be currently involved in criminal proceedings
or
|_| to have the following criminal convictions and/or to be currently involved in the following criminal
proceedings: _________________________________________________________________________; 3
6) 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;
7) not to be employed presently or not to have been employed previously as full or associate professor or
researcher - in universities or research institutions - with an open-ended contract in Italy or equivalent
contracts abroad (on the basis of ministerial tables of equivalences);
8) not to have any relationships of marriage, family relationships or affinity, up to the fourth degree, or civil
partnership, with professors belonging to the Classe di Scienze Matematiche e Naturali, or with the
Director, the Secretary General, the members of the Board of Directors of the Scuola and not to hold the
above-mentioned positions/individual functions, from the moment of authorization of the selection
procedure until the signing of the contract as a fixed-term researcher;
9) 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 continuing4;
10) 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 continuing5;
11) 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;
12) |_| 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 production6;
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 thesis7, together
with the substitute declarations of attachments B1 and B2;
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 suggests below the names of max. 3 experts in the field that he/she will contact to ask for
possible reference letters/scientific reports on the activities carried on. The letters/reports must be sent by the
experts, preferably in pdf format, directly to the email address [email protected] by the deadline.
1- (First name, Family name, Affiliation) ___________________________________________
2- (First name, Family name, Affiliation) ___________________________________________
3- (First name, Family name, Affiliation) ___________________________________________
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 445/20008. 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 signature9 ___________________
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
Time off work for maternity leave or sick leave according to the current law will not be taken into account.
5
See the previous note.
6 Please follow the indications contained in attachment B, par. 1 lett. b of the announcement.
7
If the applicant sends the candidature via PEC- Posta Elettronica Certificata, or from an electronic registered delivery service or a qualified
electronic registered delivery service, the presentation of documents and publications on paper, CD or USB flash drive is not requested.
8 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.
9 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