APPLICATION FORM

FOR SETTING UP THE POOL OF ASSESSORS
PUBLISHED IN THE FRAME OF HU-SK-RO-UA ENPI CBC PROGRAMME

I. PERSONAL INFORMATION

I.1. General Information

Name: ...................................................................................................................................

Date of birth:..........................................................................................................................

Address of permanent residence: .........................................................................................

Mailing address (if different as permanent residence): .........................................................

Mobile phone: .........................................................................................................................

e-mail:.......................................................................................................................................

Workplace: ...........................................................................................................................

Address: .................................................................................................................................

Telephone, fax: ......................................................................................................................

I. 2. Education and training (please add as many tables as necessary) 

University/ Institution (name, town):		
Dates (from - to):	
	
Principal subjects/ Qualification:		
Degree/ Certificate obtained:		

University/ Institution (name, town):		
Dates (from - to):	
	
Principal subjects/ Qualification:		
Degree/ certificate obtained:		

University/ Institution (name, town):		
Dates (from - to):	
	
Principal subjects/ Qualification:		
Degree/ Certificate obtained:		

I.3. Professional experience (please add as many tables as necessary)

Dates (from - to):
		
Name of employer and position:
		
Main responsibilities:

		

Dates (from - to):
		
Name of employer and position:
		
Main responsibilities:

		

Dates (from - to):
		
Name of employer and position:
		
Main responsibilities:

		

II.	FIELDS OF EXPERTISE 

Please indicate the major area and the domain you are interested in performing assessor activities. (More fields can be marked though in the end the assessor selected will not necessarily be contracted as assessor in all the marked fields.) 

Mark only those fields, where you have more than 5 years of experience.

Fields of expertise	
      1.   Tourism development
 Development and rehabilitation of tourism products
 Promotion, marketing and sale of tourism products    
	
      2.    Support of cross-border business cooperation
 Development of business infrastructure
 Cooperation between businesses (e.g. clusters, networks)	
3.	Protection of the environment
 Protection of nature and conservation of natural values
 Water management
 Waste management
 Renewable energy sources
 Sustainable management of natural resources
	
       4.   Emergency preparedness
 Flood prevention
 Warning systems for disasters
 Monitoring systems on environmental pollutions
 Development of local and regional strategies to mitigate the         impact of global climate change
	
      5.   Institutional cooperation
 Human resources infrastructure development
 Cooperation between educational institutions
 Cooperation between public institutions
 Integration and cooperation on the labour market
	
6.	Cooperation between communities
 People-to-people actions
 Support of local folk-art and handicraft
 Environmental awareness campaigns	
     7.   Networking, partnership development and capacity building
 Initiatives in partnership and networking, exchange of experience
 Capacity building in project planning and implementation	

III. WORK EXPERIENCE

III.1a)  Work experience in the field of programme management and finance or project cycle management
 I do posses
 I don’t posses

III.1b) Other experience
 management of EU projects 
 technical and economic feasibility studies, 
 preparation of cost-benefit analyses, financial plans
 environmental assessments
 preparation of technical, construction documentation
 project evaluation
 other (please list) ……..………………………………………………………………..

III.1c) IT literacy 
 I do posses
 I don’t posses

III.1d) Language Knowledge

English
	Hungarian	Romanian	Slovak	Ukrainian	
 Proficient or native 
 Intermediate
 Basic
	 Proficient or native 
 Intermediate
 Basic
	 Proficient or native 
 Intermediate
 Basic
	Proficient or native 
 Intermediate
 Basic
	Proficient or native 
 Intermediate
 Basic

III.2. Please describe your experience/knowledge/competence related to domestic and/or EU funds (please add as many lines as necessary)
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III.3. Description of the special fields of expertise/ expert work indicating special competencies in the fields indicated in the section II. Fields of expertise (please add as many lines as necessary)
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III.4. Please list the publications in areas concerned by the Programme you have elaborated individually or as a collection of authors (please add as many lines as necessary)
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III.5. Please present your knowledge regarding the target area of the Programme, i.e. the border counties/ regions between Hungary, Slovakia, Romania and Ukraine and your experiences about the planning and/or strategic development documents, strategies on regional, county or local level (please add as many lines as necessary)

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III.5a) Have you ever participated as assessor in project evaluation? If yes, please list the performed tasks and give data regarding the evaluation (e.g.: name of the programme or funding source, contractual authority, type of evaluated projects, subject area etc.) (please add as many lines as necessary)

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III.5b) If you have ever worked as assessor for the National Development Agency or VATI Kht. in Hungary or the respective National Authorities of Slovakia, Romania and Ukraine (Ministry of Construction and Regional Development of Slovak Republic, Ministry of Regional Development and Housing of Romania, Ministry of Economy of Ukraine) or the EC Delegation in Ukraine) please indicate them in the table below.

Contractor	Date of assignment (year)	Reference number and name of the call for proposals (if not specified, name of the Programme (grant source) and measures/activity fields concerned)
	Number of evaluated projects	

				

III.6) Membership in professional bodies, functions (please add as many lines as necessary)

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I hereby assume responsibility for the information provided in this Application Form and my  signature acknowledges that I have read and understood the Call for Assessors and concerned documents.

Date:....................................... 

………………………………………….
 Signature
ANNEXES:
1.	Curriculum Vitae (in EU format http://myeurocv.com/euroCVTemplate_en.doc)
2.	Copies of the diplomas, certifications (e.g. degree, trainings, language knowledge, etc.)