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)	My nationality is_______________________;
b)	I am physically fit for the position; 
c)	(Only for non-EU citizens who are already in Italy) I am in possession of Master’s Degree/PhD title…… awarded by(name of the University/Institution)_______________on (date)______________________
d)	(Only for non-EU citizens) I am in possession of a residence permit (please, indicate the type of permit)_________ expiring on (date) ________; 
e)	(Only for non-EU citizens ) I am not in possession of any residence permit, and therefore I request its filing, in case of the awarding of the fellowship I am applying for;
f)	To be aware that it is mandatory for Non-EU Citizens to hold a copy of the Health Insurance cover (public or private) in order to obtain the residence permit (permesso di soggiorno)*
*Nota: Enrolment to the National Health Care System (NHCS) guarantees health care assistance on the same terms as Italian nationals.
The Welcome Unit at Ca’ Foscari offers support to Research Grant holders for any queries they may have on National Health Care System enrolment procedures. Please Contact: internationalstaff@unive.it or visit www.unive.it/pag/40946/.
g)	I choose ______ as the foreign language to be tested on (if included in the research programme interview);
h)	I choose English as the language for the interview and any other test;
i)	I request the following benefits established by the Italian Law no. 104/92:
.......................................................................................................................................................
For the above mentioned purpose I enclose disability certification;
j)	I agree and undertake that I shall be bound by and comply with the terms and conditionsof the University Regulations on research Knowledge Valorisation and the attached University policy – Guidelines on IP and confidentiality in research agreements issued with Rectoral Decree n. 948 of 15/11/2022 ,if awarded the research fellowship. 
k)	I agree and undertake that I shall be bound by and comply with the terms and conditions ofthe University Regulations on Research Fellowship awarding, if awarded the research fellowship. 
l)	I agree and undertake that I shall be bound by and comply with the terms and conditions of the Code of Ethics and Conduct of Ca’ Foscari University of Venice;
m)	I agree and undertake that I shall be bound by and comply with the terms and conditions ofthe Public Administration Code of Conduct, in accordance with art. 54 Italian Law D.L. no. 165 issued on March 30th 2001;
n)	I agree and undertake that I shall be bound by and comply with the terms and conditions of the university Regulations.
o)	Furthermore, I undertake to notify any variation with respect to the above listed declarations that may occur before and during the research fellowship duration, if awarded the research fellowship. 

Date									Signature