Application form_Member BOA_2020_EN.docx



Application Formmember OF a BOARD OF APPEALEXT/20/42/AD11/BOA_memberCandidates should note that the information provided in this form constitutes the basis for appreciation of the eligibility and selection criteria established by the vacancy notice. All sections of this form must be duly completed. Candidates should provide all information in such detail that it allows for accurate appreciation. Particular attention should be paid to the section on professional experience and related fields.The information provided in this application form is subject to EU legislation on the protection of personal data and confidentiality of information.1.Surname(s)Forename(s)Maiden name (if applicable) FORMTEXT ???? FORMTEXT ????? FORMTEXT ?????2.GenderF FORMCHECKBOX FORMCHECKBOX M FORMCHECKBOX FORMCHECKBOX 3.Place of birthDate of birth (dd/mm/yyyy)Present nationality (if several, indicate all) FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????4.Address for correspondenceE-mail address FORMTEXT ????? FORMTEXT ?????Tel. Work FORMTEXT ????? FORMTEXT ?????Tel. Home FORMTEXT ????? FORMTEXT ?????Mobile Tel. FORMTEXT ?????5.Contact person?()(AND ADDRESS IF different from 4.)E-mail address FORMTEXT ????? FORMTEXT ?????Tel. Work FORMTEXT ????? FORMTEXT ?????Tel. Home FORMTEXT ????? FORMTEXT ?????Mobile Tel. FORMTEXT ?????6.Higher Education(Continue on additional sheets if necessary)6.1.Degree/Diploma obtained?() FORMTEXT ?????Field of Study?() FORMTEXT ?????Date of obtention of the Degree/Diploma?(2) FORMTEXT ?????Period of StudyFrom (dd/mm/yyyy)To (dd/mm/yyyy) FORMTEXT ????? FORMTEXT ?????University/EstablishmentName FORMTEXT ?????Address FORMTEXT ?????Standard duration of Studies to obtain this Degree/Diploma1?yr FORMCHECKBOX 2?yrs FORMCHECKBOX 3?yrs FORMCHECKBOX 4?yrs or more FORMCHECKBOX 6.2.Degree/Diploma obtained?(2) FORMTEXT ?????Field of Study?(3) FORMTEXT ?????Date of obtention of the Degree/Diploma?(2) FORMTEXT ?????Period of StudyFrom (dd/mm/yyyy)To (dd/mm/yyyy) FORMTEXT ????? FORMTEXT ?????University/EstablishmentName FORMTEXT ?????Address FORMTEXT ?????Standard duration of studies to obtain this Degree/Diploma1?yr FORMCHECKBOX 2?yrs FORMCHECKBOX 3?yrs FORMCHECKBOX 4?yrs or more FORMCHECKBOX 6.3.Degree/Diploma obtained?(2) FORMTEXT ?????Field of Study?(3) FORMTEXT ?????Date of obtention of the Degree/Diploma?(2) FORMTEXT ?????Period of StudyFrom (dd/mm/yyyy)To (dd/mm/yyyy) FORMTEXT ????? FORMTEXT ?????University/EstablishmentName FORMTEXT ?????Address FORMTEXT ?????Standard duration of studies to obtain this Degree/Diploma1?yr FORMCHECKBOX 2?yrs FORMCHECKBOX 3?yrs FORMCHECKBOX 4?yrs or more FORMCHECKBOX 7.General, Specialist and Further training or other courses(Continue on additional sheets if necessary)7.1.Training/Course attended FORMTEXT ?????Date of obtention of the Diploma/Certificate FORMTEXT ?????Period of StudyFrom (dd/mm/yyyy)To (dd/mm/yyyy) FORMTEXT ????? FORMTEXT ?????University/EstablishmentName FORMTEXT ?????Address FORMTEXT ?????7.2.Training/Course attended FORMTEXT ?????Date of the obtention of the Diploma/Certificate FORMTEXT ?????Period of StudyFrom (dd/mm/yyyy)To (dd/mm/yyyy) FORMTEXT ????? FORMTEXT ?????University/EstablishmentName FORMTEXT ?????Address FORMTEXT ?????7.3.Training/Course attended FORMTEXT ?????Date of Obtention of the Diploma/Certificate FORMTEXT ?????Period of StudyFrom (dd/mm/yyyy)To (dd/mm/yyyy) FORMTEXT ????? FORMTEXT ?????University/EstablishmentName FORMTEXT ?????Address FORMTEXT ?????8.Professional Experience please list all the positions you have occupied in your Professional career. For each professional experience inserted, please specify the exact dates and percentage of working time dedicated, and fill out all the required fields indicating how the experience is/was relevant for the profile sought. Please indicate also if the experience is/was in the FIELD of INTELLECTUAL PROPERTY AND WHETHER IT IS/WAS RELATED TO THE area of trade marks and/or designs.(Copy and paste this section as many times as necessary, Continue on additional sheets if necessary)8.1.Present or most recent post (gained after the relevant degree)From (dd/mm/yyyy)To (dd/mm/yyyy)Full-timePart-time (indicate %) FORMTEXT ????? FORMTEXT ????? FORMCHECKBOX FORMCHECKBOX FORMTEXT ?????%EmployerName FORMTEXT ?????Address FORMTEXT ?????Job Title FORMTEXT ?????Description of Duties and Responsibilities FORMTEXT ?????Was this position in the field of intellectual property? FORMCHECKBOX Yes FORMCHECKBOX NoIf yes, please specify the tasks performed.PLEASE INDICATE the exact dates spent in the field of intellectual property when they do not cover the whole period indicated above.FROM (dd/mm/yyyy)TO (dd/mm/yyyy)Was this position in the area of Trade marks and/or Designs? FORMCHECKBOX Yes FORMCHECKBOX NoIf yes, please specify the tasks performed.PLEASE INDICATE the exact dates spent in the area of trade marks and/or designs when they do not cover the whole period indicated above.FROM (dd/mm/yyyy)TO (dd/mm/yyyy)8.2.Previous Post (gained after the relevant degree)(copy and paste this section as many times as necessary, Continue on additional sheets if necessary)From (dd/mm/yyyy)To (dd/mm/yyyy)Full-timePart-time (indicate %) FORMTEXT ????? FORMTEXT ????? FORMCHECKBOX FORMCHECKBOX FORMTEXT ?????%EmployerName FORMTEXT ?????Address FORMTEXT ?????Job Title FORMTEXT ?????Description of Duties and Responsibilities FORMTEXT ?????Was this position in the field of intellectual property? FORMCHECKBOX Yes FORMCHECKBOX NoIf yes, please specify the tasks performed.PLEASE INDICATE the exact dates spent in the field of intellectual property when they do not cover the whole period indicated above.FROM (dd/mm/yyyy)TO (dd/mm/yyyy)Was this position in the area of Trade marks and/or Designs? FORMCHECKBOX Yes FORMCHECKBOX NoIf yes, please specify the tasks performed.PLEASE INDICATE the exact dates spent in the area of trade marks and/or designs when they do not cover the whole period indicated above.FROM (dd/mm/yyyy)TO (dd/mm/yyyy)8.3.Previous Post (gained after the relevant degree)(copy and paste this section as many times as necessary, Continue on additional sheets if necessary)From (dd/mm/yyyy)To (dd/mm/yyyy)Full-timePart-time (indicate %) FORMTEXT ????? FORMTEXT ????? FORMCHECKBOX FORMCHECKBOX FORMTEXT ?????%EmployerName FORMTEXT ?????Address FORMTEXT ?????Job Title FORMTEXT ?????Description of Duties and Responsibilities FORMTEXT ?????Was this position in the field of intellectual property? FORMCHECKBOX Yes FORMCHECKBOX NoIf yes, please specify the tasks performed.PLEASE INDICATE the exact dates spent in the field of intellectual property when they do not cover the whole period indicated above.FROM (dd/mm/yyyy)TO (dd/mm/yyyy)Was this position in the area of Trade marks and/or Designs? FORMCHECKBOX Yes FORMCHECKBOX NoIf yes, please specify the tasks performed.PLEASE INDICATE the exact dates spent in the area of trade marks and/or designs when they do not cover the whole period indicated above.FROM (dd/mm/yyyy)TO (dd/mm/yyyy)9.Knowledge of languagesPlease indicate all your language skills and indicate your levels where appropriate?()Mother tongue(s)Replace with mother tongue(s)Other language(s)comprehensionoral expressionwritten expressionReplace with languageSELECT LEVELSELECT LEVELSELECT LEVELReplace with name of language certificateReplace with languageSELECT LEVELSELECT LEVELSELECT LEVELReplace with name of language certificateReplace with languageSELECT LEVELSELECT LEVEL SELECT LEVELReplace with name of language certificateReplace with languageSELECT LEVELSELECT LEVELSELECT LEVELReplace with name of language certificateReplace with languageSELECT LEVELSELECT LEVELSELECT LEVELReplace with name of language certificatedo you have professional experience of working in a language other than your mother tongue? FORMCHECKBOX Yes FORMCHECKBOX NoIf yes, please indicate the language(s) in which you work/worked and the type of tasks YOU performed in these languages.please indicate your language of interview, in the event you are invited.This language needs to be one of the FIVE languages of the euipo, and different from your mother tongue.SELECT LANGUAGE10.Technical Knowledge and/or ExperiencePlease indicate any further information relevant for the assessment of criterion 4a) of the vacancy notice, in particular: professional experience in legal case handling or equvalent activities, professional judicial experience or experience in litigation, preparation and/or follow up of court cases, knowledge of ip legislations and case-law, in particular eu trade mark and designs legislation, knowledge of the european ip environment, including counterfeiting and infringement matters. FORMTEXT ?????11.other experience and knowledgePlease indicate any further information relevant for the assessment of criterion 4c) of the vacancy notice, in particular: ability to work in a multicultural and/or international environment. FORMTEXT ?????Do you have professional experience in a multicultural and/or international environment? FORMCHECKBOX Yes FORMCHECKBOX NoIf yes, please specify where this experience was acquired and its duration.12.Publications(Continue on additional sheets if necessary)Type of publication(books, articles, lectures, etc.)YearTitleContent FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????13.relevant memberships of professional associations or similarPlease indicate any relevant memberships of professional associations or similar FORMTEXT ?????14.Other relevant information YOU WISH TO DRAW TO THE ATTENTION OF the PREPARATORY SUBCOMMITTEE FORMTEXT ?????15.Period of notice required to leave your present post FORMTEXT ?????Final DeclarationI declare on my honour that the information provided in this form is true and complete?() FORMCHECKBOX yes FORMCHECKBOX noi declare on my honour that i am a national of one of the member states of the eu FORMCHECKBOX yes FORMCHECKBOX noi declare on my honour that i have not been convicted or found guilty of any criminal offence by any court FORMCHECKBOX yes FORMCHECKBOX noif appointed, i confirm my willingness to make a declaration of commitment to act independently in the public interest and in relation to interests THAT might be considered prejudicial to my independence FORMCHECKBOX yes FORMCHECKBOX noDate (dd/mm/yyyy) FORMTEXT ?????...............................................................................................Name/Signature FORMTEXT ?????...............................................................................................Please note that only the information included on this application form will be taken into consideration. CVs or any other document(s) will not be assessed.The completed form should either:BE SENT BY E-MAIL TO MBBCSecretariat@euipo.europa.euBE SENT BY COURIER TO:Chairperson of the Management BoardEuropean Union Intellectual Property OfficeAvenida de Europa, 403008 ALICANTESPAINIf sent by courier, please mark the envelope as follows:CONFIDENTIALNOT TO BE OPENED BY THE MAIL SERVICE ................
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