FORMULAIRE DE CANDIDATURE APPLICATIONN FORM LEONARDO DA VINCI MOBILITY PROJECTS

Transcription

1 FORMULAIRE DE CANDIDATURE APPLICATIONN FORM LEONARDO DA VINCI MOBILITY PROJECTS A remplir eu portugais, où dans la langue du pays visé To complete in portuguese, or in the language of the country you intend to go Fiche Signalétique du candidat Applicant s identity form Nom: Surname: Prénom: First name: Date et lieu de naissance: Date and place of birth: Sexo: Sex: Nationalité: Nationality: État civil: Marital status: Adresse du domicile: Home address: Pays: Country: Téléphone avec indicatif: Phone with country and area code: Mobile phone: A renvoyer à: Rua de Salazares, PORTO To be send to: Tel. (351-22) Fax (351-22) info@apgei.pt Endereço internet: Surname (recall): LEONARDO application form page 1/4

2 Formation Education Établissement d enseignement superior et section Higher education establishment and section: Titre du diplôme où de la formation suivie: Title of current diploma or training: Nom, adresse et numero de téléphone du professeur qui suit le stage LEONARDO Name, address and phone number of the tutor following the LEONARDO TRAINING: Nombre d années d études post-secondairs pour l obtention du diplôme: Number of years of post-secondary studies leading to your degree: Année actuelle des études: Present year of the study: Quand devenez-vous obtenir où quand avez-vous obtenu votre diplôme? When do you expect to obtain or when have you obtained your diploma? Status : Étudiant / Student: Recem-Diplomé / New graduate: Stage intégré au cursus de l étudiant: oui non Placement fully recognized as a part of the student programme: yes no Rédaction d un rapport de stage: oui non Training report: yes no Employeur De/a Type de Travail Employer From/to Type of Work Surname (recall): LEONARDO application form page 2/4

3 Connaissances linguistiques Linguistic abilities Faibles Weak Moyenne Fair Bonnes Good Pays d accueil Host country Avez-vous effectué des sejours Choix Langues linguistiques à l étranger? Choice 1 2 Si oui, où et quand? Languages Have you had linguistic training abroad? B Belgique It yes, where and when? Belgium D Alemagne Germany DK Denemark Denmark E Espagne Description du stage Spain Description of the placement F France France GB Royaume-Uni Durée (de 3 a 12 mois): United Kingdom Duration (from 3 to 12 months): GR Gréce Greece I Italie Période souhaitée: de a Italy Required period: from to IRL Irlande Ireland L Luxembourg Tailles de l entreprise employé Luxemburg Size of enterprise employees NL Pays-Bas Netherlands < >500 P Portugal Portugal A Austriche Austria Type d activité: Area of activity: FL Liechtenstein Liechtenstein Production Manufacture IS Islande Aintenance Maintenance Engineering Iceland Vente et Marketing Sale a Marketing N Norvége Administration Personnel Personnel Administration Norway Gestion General General Management S Suéde Autre Other Sweeden SF Finlande Finland Vos atouts: Loisirs, sports, voyages, divers Your assets: hobies, sports, journeys, other interests Surname (recall): LEONARDO application form page 3/4

4 Autres Informations Other Information Décrivez le type de travail que vous souhaitez effectuer pendant le stage LEONARDO, la branche d activité et le type d entreprise, la mission à accomplir dans celle-ci, la relation du stage avec vos etudes et ce que vous recherchez par celui-ci. Pourquoi avez-vous choisi vos études actuelles? Souhaitez-vous oursuivre une carrière a orientation technique ou administrative? N oubliez pas que LEONARDO finance des stages de formation! Describe the kind of work you would particularly like to do, the branch of activity and type enterprise, the tasks to be accomplished in the enterprise and its relevance to your course of study and the training you aim to acquire during the LEONARDO placement. Why did you choose your particular course of study? Do you want to pursue a technically oriented or management orientated career? Keep in mind that a LEONARDO placement is for training! Je soussigné, certifie que les renseignements mentionnés dans cette demande sont exacts la communication de ces informations aux enterprises. PHOTO The undersigned certify that the information given in this application is correct and authorize to have any part of this information communicated to the enterprises. Date: Signature: Surname (recall): LEONARDO application form page 4/4

5 DOCUMENTOS A ANEXAR A ESTE FORMULÁRIO 1. Fotocópia do Certificado de Habilitações 2. Informações sobre Entidade Bancária: Designação completa do banco; Designação completa da Agência ou Balcão; Endereço completo da Agência ou Balcão; Número da Conta Bancária; Código NIB. 3. Carta de Aceitação em Papel Timbrado da Entidade Receptora, assinada pela(o) Orientadora(o) do Estágio. Informação obrigatória que deve constar nesta carta: Nome completo da(o) Bolseira(o); Duração do Estágio; Período de Estágio; Conteúdo Programático do Estágio. 4. Curriculum Vitae 5. Modelo E111 Seguro de Assistência Médica em Viagem 6. Seguro de Responsabilidade Civil e Acidentes Pessoais Individual 7. Fotocópia Bilhete de Identidade