Application for admission
Abilita JavaScript nel browser per completare questo modulo.
Enable JavaScript in your browser to complete this form.
Name
*
Last name
*
Phone
*
Email
*
Hospital
*
Business unit name
*
Working address
Address (line 1)
Address (line 2)
City
State/Province/Region
ZIP Code
--- Select country ---
Afghanistan
Albania
Algeria
Andorra
Angola
Eel
Antarctica
Antigua and Barbuda
Saudi Arabia
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belgium
Belize
Benin
Bermuda
Bhutan
Belarus
Burma
Bolivia (plurinational state of)
Bonaire, Saint Eustatius and Saba
Bosnia-Herzegovina
Botswana
Brazil
Brunei Darrussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Chad
Chile
China
Cyprus
Colombia
Comoros
Congo
Congo (Democratic Republic of the)
Costa Rica
Ivory Coast
Croatia
Cuba
Curaçao
Denmark
Dominica
Ecuador
Egypt
El Salvador
United Arab Emirates
Eritrea
Estonia
Ethiopia
Russian Federation
Fiji
Philippines
Finland
France
Gabon
Gambia
Georgia
South Georgia and the South Sandwich Islands
Germany
Ghana
Jamaica
Japan
Gibraltar
Djibouti
Jordan
Greece
Grenada
Greenland
Guadeloupe
Guam
Guatemala
Guernsey
French Guiana
Guinea
Equatorial Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
India
Indonesia
Iran (Islamic Republic of)
Iraq
Ireland (Republic of)
Iceland
Bouvet Island
Isle of Man
Christmas Island
Island of Saint Barthélemy
Aland Islands
Cayman Islands
Cocos Islands (Keeling)
Cook Islands
Falkland Islands (Malvinas)
Faroe Islands
Heard and McDonald Islands
Northern Mariana Islands
Marshall Islands
Norfolk Islands
Saint Pierre and Miquelon Islands
Solomon Islands
Svalbard and Jan Mayen Islands
Turks and Caicos Islands
Virgin Islands (U.S.)
Virgin Islands (British)
Minor outer islands of the United States of America
Israel
Italy
Kazakhstan
Kenya
Kyrgyzstan
Kiribati
Korea (People's Democratic Republic of)
Korea (Republic of)
Kosovo
Kuwait
Lesotho
Latvia
Lebanon
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
North Macedonia (Republic of)
Madagascar
Jersey
Malawi
Maldives
Malaysia
Mali
Malta
Morocco
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia (Confederation of States of)
Moldova (Republic of)
Monaco
Mongolia
Montenegro
Montserrat
Mozambique
Namibia
Nauru
Nepal
Nicaragua
Niger
Nigeria
Niue
Norway
New Caledonia
New Zealand
Oman
Netherlands
Pakistan
Palau
Palestine (State of)
Panama
Papua New Guinea
Paraguay
Peru
Pitcairn
Poland
French Polynesia
Puerto Rico
Portugal
Qatar
United Kingdom of Great Britain and Northern Ireland
Arab Republic of Syria
Czech Republic
Central African Republic
Lao People's Democratic Republic
Dominican Republic
Reunion (Island of)
Romania
Rwanda
Western Sahara
Saint Kitts and Nevis
Saint Vincent and the Grenadines
Saint-Martin (French part)
Samoa
American Samoa
San Marino
St. Helena, Ascension and Tristan da Cunha
Saint Lucia
Sao Tome and Principe
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten (part of the Netherlands)
Slovakia
Slovenia
Somalia
Spain
Sri Lanka
United States of America
Vatican City State
South Africa
Sudan
South Sudan
Suriname
Sweden
Switzerland
Tajikistan
Taiwan, Republic of China
Tanzania (United Republic of)
French Southern Territories
British territory in the Indian Ocean
Thailand
East Timor
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Ukraine
Uganda
Hungary
Uruguay
Uzbekistan
Vanuatu
Venezuela (Bollivian Republic of)
Vietnam
Wallis and Futuna
Yemen
Zambia
Zimbabwe
eSwatini (Kingdom of)
Nation
CV upload signed and dated
*
Drag & Drop Files,
Choose Files to Upload
Pursuant to D.P.R.445/2000, it is hereby declared that the information contained in this resume is true. I authorize the processing of the personal data contained in my curriculum vitae according to art. 13 of Legislative Decree 196/2003.
Self-certification of registration with the SIN
*
Drag & Drop Files,
Choose Files to Upload
Level POLICY designation
Self-certification of years of service in the NICU
Drag & Drop Files,
Choose Files to Upload
at least 4 years of service in a Neonatology and NICU Complex Facility
Case history certified by the Director/Manager of the relevant NICU
Drag & Drop Files,
Choose Files to Upload
the case history certified by the NICU director/manager of echocardiographies in the neonatal period performed in the last two years (i.e., number of examinations performed in the NICU on an inpatient basis; echocardiographies performed on an outpatient basis are not considered)
Level II University Master's Degree in Pediatric Cardiology
Drag & Drop Files,
Choose Files to Upload
Preference 1 pediatric cardiology
*
Preference 2 pediatric cardiology
*
Preference 3 pediatric cardiology
*
Preference 1 neonatal intensive care
*
Preference 2 neonatal intensive care
*
Preference 3 neonatal intensive care
*
DECLARATION OF CONSENT TO THE PROCESSING OF PERSONAL DATA, PRIVACY AND POLICY
*
I give consent
I do not give consent
PRIVACY AND POLICY
Send