To the Director of the Department/Centre/… ______________
of Ca’ Foscari University of Venice 
(address of the Department/Centre/…)

I, the undersigned ___________________________ 
born in (City/Town name)______________________________ (Province/Region of _________, Country ___________) on (date) _______________, passport no. _____________ taxpayer’s code no. (if available) __________________________________ 
resident in (City/Town name) __________________ (Province/Region of _________, Country ___________) in Street/Square/…____________________ (indicate the street/square name) no. _____, postcode _____________, nationality ________________, tel.(national prefix included) __________________ mobile number (national prefix included)  ______________________,   email address___________________________
hereby submit

my application for the public selection based on qualifications and interview, and any other test, for the research fellowship within the scope of: 
OPTION A the research programme: “_____________________” related to a specific sector or SettoreScientificoDisciplinare (SSD) [Educational Sector Codes] _____, as per procedure announced by call Ref. no.   _________ dated_______
OPTION B the research Area: “_____________________” , as per procedure announced by call Ref. no.   _________ dated_______

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 that:

a)	I have already submitted an individual proposal such as Marie Skłodowska Curie Actions - Individual Fellowships/ERC Starting Grant/FIRB (Italian Fund for basic research investments)/SIR (Scientific Young Independence Research) or similar (please delete as appropriate), with the title (please, indicate the name of the project)________, and having passed all the evaluation thresholds, as established by the related notice(please indicate the title and – if appropriate – the code of  the notice) ____________. The proposal obtained the following evaluation:_____ (please attach any relevant evaluation summary report);
b)	I have already completed an individual project under Marie Skłodowska Curie Actions - Individual Fellowships/ERC Starting Grants/FIRB (Italian Fund for basic research investments) / SIR (Scientific Young Independence Research), or similar funded projects, with the title (please, indicate the name of the project and its start and end dates)________, submitted under the programme (please, indicate the name of the programme and the related notice)________________________. (Please attach relevant evaluation summary report);
c)	I am aware that the research fellowship is not compatible with the positions indicated in art. 4 c. 8 and 18 of the Regulations on research fellowships awarding and the current laws;
d)	I am / I am  not (delete as appropriate) a permanent employee of any private-sector body and I declare that I am a part time employee / I am not a part time employee (delete as appropriate); furthermore, I am aware that the research fellowship is not compatible with the positions indicated in art. 4 c. 8 and 18 of the Regulations on research fellowships awarding and the current laws.