EMSA Traineeship Scheme 2014
Standard application form
[All the required fields shall be filled electronically in EN !"S#$ 1% Applicant&s personal data Surname: Maiden name: Gender: Male Female Country of birth: Date of birth: Place of birth: Forename(s): Present nationality:
2% 'reference of (nit Please clearly indicate, the (nits that interest you the most in order of preference. (Please see Traineeship notice) First choice nit:
Second choice nit:
Pa!e " of #
)% Education and Trainin* (add boxes as necessary). 'lease enclose a copy of your uni+ersity diploma ,hen sendin* in your application% Dates: $itle of %ualification a&arded: 'ame and type of or!anisation: (e)el of de!ree: (ocation: Principal sub*ects and or!anisational s+ills co)ered:
Dates: $itle of %ualification a&arded: 'ame and type of or!anisation: (e)el of de!ree: (ocation: Principal sub*ects and or!anisational s+ills co)ered:
Dates: $itle of %ualification a&arded: 'ame and type of or!anisation: (e)el of de!ree: (ocation: Principal sub*ects and or!anisational s+ills co)ered: 4% 'rofessional e-perience. employment or traineeship /add boxes as necessary)
From: 'ame of employer: $ype of employment: $emporary employee Description (Max 100 words): Paid trainee
$o:
npaid,-oluntary
Permanent employee
Self employed
Pa!e . of #
From: 'ame of employer: $ype of employment: Paid trainee Permanent employee /ther Description (Max 100 words):
$o:
npaid trainee $emporary employee
-oluntary &or+ Self employed
0. Have you already worked for a European Institution or Body? 1% 2no,led*e of lan*ua*es
0es
'o
1n order for the $rainee to fully profit from the professional trainin! and to be able to follo& meetin!s and perform ade%uately, all candidates must ha)e a )ery !ood +no&led!e of at least t&o Community lan!ua!es, of &hich one should be 2n!lish, the &or+in! lan!ua!es of 2MS3. Candidates from $hird countries need to ha)e )ery !ood +no&led!e of 2n!lish. Please use the follo&in! self4assessment scale (5) to indicate your le)el of +no&led!e: !an*ua*e Mother ton*ue/s3 42 41 52 51 A2 A1
(*) Common European Framework of
eference (CEF) le!el
6% S7ills and 4ompetences
4omputer s7ills Technical s7ills and competences
Pa!e 6 of #
4ommunication and or*anisational s7ills 8ther rele+ant s7ills
9% Studies or publications on E(: EMSA or Maritime related topics 7a)e you studied or published papers or articles on 2MS3 or Maritime related topics, or are you preparin! any such studies8 0es 'o
1f so, please specify up to three and !i)e details (ma9imum "#: characters per entry).
;%
<equested duration of the Traineeship 6 months ; months # months
10% 'ermanent address and contact details
Street,'<: Postcode,=ip: $o&n,Pro)ince: $elephone: 2mail address: Country: Mobile phone:
11% Additional personal information
Pa!e ; of #
Do you ha)e a physical disability that may re%uire special arran!ements to be made if you are chosen8 0es 'o
1f =ES, please !i)e details and indicate the nature of the special arran!ements you belie)e &ould be necessary ("#: &ords ma9imum):
12% Moti+ation !etter (Ma9 .#: &ords) Please *ustify your application and interest in the $raineeship Scheme and pro)ide any additional rele)ant information
>eclaration
1 certify that the statements made by me in ans&er to the abo)e %uestions are true, complete, and correct to the best of my +no&led!e and belief. 1 understand that any false statements or any re%uired information &ithheld from this form may pro)ide !rounds for my e9clusion from the $raineeship Scheme or cancellation of my trainin! if my application has been accepted. 1 enclose a copy of the uni)ersity diploma (see art. ... of the Decision)
>ate.
Si*nature /hand,ritten3.
Pa!e # of #
