TO THE RECTOR 
OF UNIVERSITA’ POLITECNICA
DELLE MARCHE 
	VIA MENICUCCI, 6
							60121 ANCONA

Subject:	Appointment of professor for module  _______________________________________
		Academic Year 2018/19

	The Undersigned_________________________________born in___________________________
on_________________ place of residence__________________ address ___________________________
CAP (zip code)_______________, e-mail__________________________________________  tel.__________________________________________ codice fiscale (Italian tax identification code) ___________________________________ VAT number _________________________________
hereby applies

for admission to the selection for the appointment under a temporary employment contract  of a professor for the teaching module of __________________________________________________________________ of the Master Degree Course in “Food and Beverage Innovation and Management” of the Department of Agricultural, Food and Enviromental Sciences. The module will be taught in English 

To this end, the Undersigned 

DECLARES

under his/her own responsibility, being aware of the provisions laid down in Art. 76 of Presidential Decree of December 28, 2000, nr. 445 on legal liability in the case of forgery and false statements 

•	not to be related within the fourth degree by kinship or marriage to the Rector, the General Manager, any member of the governing body, any professor or researcher of the appointing University; 
•	to be currently working as ______________________________________________________________
_____________________________________________________________________________________
at _________________________________________________________________________;
•	to have been awarded the Master’s degree of the new or old University system, in ______________________________________________________________ at _________ 
_______________________________on____________________;
•	to have been conferred with a doctoral degree on ________________ at ______________________________________________;

•	to be aware that personal data contained in the application and the Curriculum Vitae may be disclosed by Università Politecnica delle Marche during the recruitment and selection process or for other institutional purposes, according to the Italian Legislative Decree no. 196/2003. 

Should the application be approved, the Undersigned asks that the notice thereof be sent: 
to the above-indicated email address 
or 
 per A/R registered letter 

DATE................................

								SIGNATURE........................................ 

ATTACHMENTS:
- curriculum vitae (the curriculum vitae, for the mandatory publication on the University website, must be sent in European format and in PDF/A (less than 2 MB in size) to the e-mail address contratti.supplenza@univpm.it with the following name: SurnamenName -lecturer-on-contract)
- list of publications;
- additional awarded titles;
- module content and textbooks to be adopted