ANNEX 1 
APPLICATION FORM

To the Director
INAF-Osservatorio Astrofisico di Catania
Via S. Sofia, 78
95123 Catania, Italy

I, the undersigned (Forename(s))......................................... (Surname)...........................................................
Place of bird (Town/State/Country)...............................................................
Date of birth (dd/mm/yy) ....................
Nationality ……………………………
Gender ………………
Permanent residence address (number/street/town/postal code/Country): ………………………………………………………….
Email address: …………………………………………………… Possibly PEC: ………………………………
Hereby apply  to participate to the selection for the awarding of one research grant entitled: “Photochemistry on the space station (PSS)” D.D. 183/14, agree to the processing of my personal data, in accordance with Italian Leg. Decree n. 196/2003, for the purposes of the present selection procedure, having read the mentioned Call for application,
REQUEST
to apply for the above mentioned fellowship, and, to this end, aware that false declarations are punishable by law and that producing false statements and forged documents, as well as the use of forged documents shall be punished in accordance with the Criminal Code and with any other applicable special acts on this matter, and that the Administration will carry out random checks on the accuracy of the declarations made by candidates,
DECLARE
under my own responsibility:
•	My personal data are (name(s) and surname, date and place of birth, nationality, place of residence, possibly fiscal code): ……………………………………………………………………………………………………………;
……………………………………………………………………………………………………………..;
……………………………………………………………………………………………………………..;
……………………………………………………………………………………………………………..;
•	my nationality is: .............................;
•	to enjoy civil and political rights of the State of which I hold citizenship;
•	not to have been in the past or not to be at present under any penal sentence (if liable, please specify) ...................................................;
•	that I hold the following PhD degree in…………………………………… awarded by…………………………………………… on date…………………………………………   Title of thesis ………………………………………………………………………………………;
or
•	that I hold the following Degree in ………………………………………………,
awarded by……………………………………………………… on date…………………………. with mark__________, together with at least three years of documented experience in scientific or technological activities (list research grants and/or fellowships hold in the past, length and host Institution): ……………………………………………………………………………………………………………………..;…………………………………………………………………………………………………………………….;
…………………………………………………………………………………………………………………….;
(Only If the qualification has not been deemed valid for Italian law), I request the validity of the PhD degree (or of the degree) for the sole purposes of participation in the present competition and, to this end, I attach: 
a)for Italian and EU citizens: personal sworn declaration pursuant to D.P.R. 28/12/2000 n. 445 and successive modifications, together with the university qualifications awarded complete with a list of examinations taken, the relative marks and duration of the course; 
or
b) for non-EU citizens: originals or suitably certified copies of all academic qualifications translated into Italian or English and legally validated with a list of the examinations taken, the relative marks and the duration of the course. The declaration of  value is issued by the competent Italian diplomatic representatives in the country where the institution that made the award is based.
•	that submitted copies of publications and private documents are conformal copies of the original documents (only for EU citizens);
•	that I hold other titles and qualifications indicated in the curriculum attached (e.g. specialization diplomas, attendance certificates for post-graduate specialization courses held in Italy or abroad, documented research, under contract, conducted at public or private bodies, scholarships or appointments, both in Italy and abroad);
•	that I am aware of the restrictions described in Article 4, of the Call for applications for this research fellowship and that I’m an employee of the following public administration: ……………………………………………………………….
or I’m not an employee of public administration;
•	that I have never received a research award as per art. 22, Italian Law 240/2010;
or
•	that I have previously received a research awards as per art. 22, Italian Law 240/2010 and, in particular I have been the recipient of:
•	a research fellowship entitled …………………………………………………………,
at (name of the institution)…………………………………………………….,
beginning…………… ending …………….total months …………………..
•	a research fellowship entitled …………………………………………………………,
at (name of the institution)…………………………………………………….,
beginning……………ending…………….total months …………………..
•	a research fellowship entitled …………………………………………………………,
at (name of the institution)…………………………………………………….,
beginning……………ending…………….total months …………………..
•	that I am not a retired person; 
•	that I am aware that, under art. 22 Italian Law 240/2010, the research fellowship:
•	cannot be held contemporarily with attendance at academic courses, “laurea specialistica” academic courses, and “laurea magistrale” academic courses, as well as with attendance at PhD courses with fellowship;
•	cannot be held contemporarily with other fellowships of whatever kind, except those awarded with the aim of integrating the training or research activity of the fellowship holder through a period spent abroad;
•	cannot permit aggregation of income from working activities, also part-time, carried out continuously;
•	cannot be awarded to those who have Research fellowships under article 22 of Italian Law 240/2010 for a total period exceeding four years, including extensions, but excluding the periods in which the grant has been held in coincidence with doctoral studies up to the maximum legal time limit of the course and excluding periods of maternity leave or sick leave, in accordance with current legislation;
•	cannot be awarded to those who have signed contracts, pursuant to Art. 22 (Research grants) and Art. 24 (Temporary research positions) of Law n. 240 dated 30 December 2010, with other universities and/or other Italian public institutions, whose duration together with that of the contract outlined in this call, exceeds 12 years, even when non-continuous, as set out in Art. 22, comma 9 of the cited Law; maternity leave and sick leave are not taken into consideration when calculating the time limit.
•	that I wish to receive any communication relating to the selection at the following address and that I will give due notice of any change of address:
Address (number/street/city/postal code/Country): ……………………………………………..........………………………………………………… 
Email address: ………………………………………………………
If possible list also PEC: ……………………………………………………..
I attach to this form:
-	Self-declaration (Annex 2) (only for EU citizens);
-	“Curriculum vitae”, signed and dated, providing evidence of possession of the skills required to carry out the research and including a list, if applicable, of grants and fellowships held in the past;
-	copy of a valid identity document (ID card or passport);
-	list of publications , including all authors;
-	any other qualification, working task, research activity at public and private institutions and publications that the applicant deems appropriate to submit;

Only for non EU citizens residing outside Italy, I attach to this form:
-	originals or suitably certified copies of all academic qualifications, certificates of attendance to post-degree courses, Fellowships, Research contracts/grants at private and/or public institutions, or other, obtained outside Italy, together with a declaration of value, certified, translated and legally validated, complete with an indication of the examinations taken, relative marks and course duration. (The declaration of value is issued by the competent Italian diplomatic representatives in the country where the institution that made the award is based.)

I will communicate promptly any changes in the positions referred to in the application.

I undersigned authorize the Administrative Office of INAF-Osservatorio Astrofisico di Catania to process my personal data only for the purpose of the present selection.

Place and date (dd/mm/yy)

					(Applicant’s signature, not to be authenticated)

						___________________________
ANNEX 2 
self-declaration (only for Italian and EU citizens)

I, the undersigned (Forename(s))....................... (Surname)....................................
Place of birth (Town/State) ..................................
Date of birth (dd/mm/yy) ....................
Permanent residence address (number/street/town/postal code/Country) ……..……………..,
As candidate to the selection for one research grant issued by INAF-Osservatorio Astrofisico di Catania with Director’s Decree n. 183/14, aware that producing false statements and forged documents, as well as the use of forged documents will be punished in accordance with the Criminal Code and with any other applicable special acts on this matter, and that this Administration will carry out random checks on the accuracy of the declarations made by candidates

DECLARE AND SELF-CERTIFY
UNDER  MY OWN RESPONSIBILITY

1)	THAT THE CONTENT OF THE ATTACHED SIGNED “CURRICULUM VITAE” IS TRUE
2)	(Only If the qualification has not been deemed valid for Italian law and only for Italian and EU citizens), that  I hold the following PhD Degree (or Degree) and I took the following examinations with the relative marks and that the duration of the course is ……………………………………….

Place and date (dd/mm/yy)

         (full applicant’s signature)

							_____________________________

N.B. A photocopy, not authenticated, of a valid identity document of the applicant must be attached.