Formulário Geral de Aplicação de Estágio General Trainee Application Form

Transcrição

1 CAEP Brasil Intercâmbio CNPJ / Av. Paulista, 1471 Conj.1503 CEP São Paulo, SP Brasil Telefone/Fax: + 55 (11) info@caep.com.br Site: Attach your picture Formulário Geral de Aplicação de Estágio General Trainee Application Form 1. Nome conforme consta no passaporte / Name as it appears in your passport: / / Sobrenome / Last Name Nome do meio / Middle Nome / First Name 2. Masculino / Male Feminino / Female 3. Ocupação atual / Current Occupation: 4. Endereço / Present address: / Rua e/ou caixa postal / Street or P.O. Box Número / Box-number / / / CEP / Postal Code Cidade / City Estado / State-Province País / Country 5. Telefone / Phone: / Celular / Mobile: / Código de area / Area Code número / number Código de area / Area Code número / number Passaporte - validade / Passport nº - valid until: 6. Cidadão legal do / Legal Citizen of (País / Country) Residente legal permanente do / Legal permanent resident of: (País / Country) 7. Data de Nascimento / Date of Birth: / / (dia / mês / ano day / month / year) Local de Nascimento / Place of Birth: - (Cidade / City País / Country). 8. Contato de Emergência / Emergency Contact: Nome / Name: / Endereço / Address número / box number / / / CEP / Postal Code Cidade / City Estado / State-Province País / Country Telefone / Phone: 9. INFORMAÇÕES DO PROGRAMA / PROGRAM INFORMATION Em que área você se interessa? / What Placement category do you want? Agricultura / Agriculture Horticultura / Horticulture Enologia-Vinicultura / Enology-Winery Equinos / Equine Duração do estágio / Length of program requested Meses / Months Data de início / starting date / / (dia / mês / ano day / month / year)

2 Áreas de interesse / Field of interest Escolha A, B, C, D ou E. Em seguida, enumere de 1 a 3, sendo 1 (um) a maior preferência. Choose A, B, C, D or E. After, rank your choice 1 to 3, being number 1 (one) for your highest interest. A) AGRICULTURA / AGRICULTURE Grãos / Field Crops Gado De Corte / Beef Gado Leiteiro / Dairy Suínos / Pigs Fazenda Mista / Mixed Farming Cana-de-açúcar / Suga-cane B) HORTICULTURA / HORTICULTURE Plantas de vaso / Potted plants Flores de corte / Cut Flowers Frutas / Fruit Vegetais / Vegetables Paisagismo / Landscaping Viveiros de mudas / Tree nursery C) ENOLOGIA-VITICULTURA / ENOLOGY-VITICULTURE Adega / Cellar Laboratório / Laboratory Viticultura / Viticulture D) EQUINOS / EQUINE Competição; Lazer / Competition; Pleasure Reprodução / Breeding Corrida / Racing Veterinária / Veterinary Rancho / Western E) OUTRA ÁREA AGRÍCOLA / OTHER AGRICULTURE AREA: Se você se interessa por outras áreas, favor detalhar: If you are interested in another fields, please specify: F) Liste especificamente experiências que você possui relacionadas à área escolhida. Na sua autobiografia, descreva detalhadamente sua experiência nas categorias escolhidas. List specific experience practical that you have relating to your choice. In your autobiography describe in more detail your experience in your chosen categories G) Liste especificamente maquinários que você já operou relacionadas à área escolhida. List specific machinery you have operated relating to your choices: H) Liste cursos de graduação ou técnicos e cursos que você já realizou relacionadas à área escolhida. List College or technical school or courses you have completed that relate to your choice:

3 10. OUTRAS INFORMAÇÕES IMPORTANTES / OTHER IMPORTANT INFORMATION a) Você tem possui pelo menos 1 ano de experiência na área pretendida? Sim / Yes Have you had at least one year of practical experience in the placement you requested Tipo de atividade / Type of work Duração da experiência, anos/meses / Length of experience, Year/months / / b) Você foi criado em Fazenda, negócio de Horticultura ou de Eqüinos? Were you raised on a Farm, Horticulture or Equine business? Sim, um negócio de / Yes, a business A sua família possui Fazenda, negócio de Horticultura ou de Eqüinos? Does your family operate a Farm, Equine or Horticultural business? Sim, um negócio de / Yes, a business c) Você já teve algum tipo de visto ao Brasil negado? / Have you been denied any type of visa to Brazil? Sim, um visto de / Yes, a visa (type of visa) Você já esteve no Brasil? / Have you been in Brazil before? Sim, com visto de de meses / Yes, with a Visa (type of visa), for months d) Experiências de intercâmbio anteriores internacionais ou nacionais: Previous international or domestic exchange experience: Tipos de intercâmbio País, se é o Brasil, tipo de visto Mês/ano Duração do programa Types of exchange Country If Brazil, type of visa Month/year Length of program / / / / e) Avalie suas habilidades: / Rate your ability: Conversação Português / Speaking Portuguese Compreensão Português / Understanding Portuguese Leitura Português / Reading Portuguese f) Classifique o tipo de acomodação que mais prefere (a escolha não pode ser garantida). Rank your choice of living arrangements (choice can not be guaranteed). Casa de família com quarto individual / Live in the family home with own room Acomodação separada / Live outside of the family home Sem preferência / No Preference

4 g) Que tipo de atividades culturais você gostaria de participar enquanto estiver no Brasil? Se preferir, detalhe na autobiografia. What cultural activities would you like to participate in while in Brazil? You can detail it on your autobiography if needed. h) Quais os três principais objetivos que pretende alcançar com o Visto VITEM-I? Se preferir, detalhe na autobiografia. What are the three major goals you would like to accomplish while on a VITEM-I Visa*? You can detail it on your autobiography if needed. * VITEM-I refers to the Brazilian temporary visa. i) Você possui carteira de motorista válida? / Do you have a valid driver's license? Sim / Yes (É obrigatória a carteira internacional antes de sua chegada / You must have an International driver s license before arrival) Carro / Car Empilhadeira / Forklift Caminhão / Commercial truck license Outros / Other: j) Fumante / Smoke: Sim / Yes k) Ingere álcool? / Drink alcohol? Sim, com moderação / Yes, in moderation l) Estado civil / Marital status: Solteiro / Single Casado / Married Com filhos / with Children Sem filhos / with not Children HEALTH INSURANCE COVERAGE It is required that the student/trainee must have travel health insurance, that VITEM-I trainees be covered by medical and accident insurance. The policy must cover from the date of arrival in Brazil and the entire length of the VITEM-I, including travel time. 1. Medical benefits per accident or illness; 2. Repatriation of remains; 3. Expenses associated with the medical evacuation of the exchange visitor to his or her home country. FOR COUNTRY PARTNER USE ONLY! Trainee will order: CAEP Health Insurance. Covers and exceeds requirements. At a cost of USD $85.00 per month (fee is subject to change without notice). Country partner Health Insurance. Country Partner collects all premiums and submits dates of coverage prior to arrival of the trainee. Failure to submit this information prior to the arrival, CAEP will order insurance for the trainee. / / Country Partner Representative Signature / Stamp Day Month Year

5 11. FOTO E CÓPIA DO PASSAPORTE / PASSPORT & COPY OF PASSPORT: a. Incluir uma foto sua (igual do passaporte) digital ou scaneada. Please enclose a digital or scaned photo (passport size) of yourself. b. Incluir uma cópia do seu passaporte constando nome e data de nascimento. Enclose a copy of your passport that shows your name and birth date. 12. REFERÊNCIAS / REFERENCES: Por favor, inclua 2 cartas de referências, preferencialmente de ex-empregadores. As referências devem incluir informações sobre habilidades de trabalho, hábitos, comunicação, etc. Please enclose 2 letters of references, prefers from past employers. Letters should include information about your work habits, communication and social skills, etc. 13. AUTOBIOGRAFIA / AUTOBIOGRAPHY: Enviar uma autobiografia, com no máximo duas páginas, incluindo informações sobre: Experiências profissionais, habilidades de trabalho, qualificações adicionais e pessoais, planos para o futuro e expectativa com o programa de intercâmbio. Podem-se incluir também hábitos e costumes, crenças, dieta alimentar, sobre a família, hobbies, esportes. Please enclose an autobiography, two pages typed maximum, which must include: Work experience, practical and special skills, additional qualifications and personal maturity, plans for the future and expectations for the program. It s possible to include also about hobbies, sports, weaknesses, likes, dislikes and hopes, diet, family background, etc. 14. THE FOLLOWING CONDITIONS ARE ESTABLISHED BY CAEP Brasil This Declaration must be completed, signed and dated by all CAEP Brasil applicants. List all physical and/or mental disabilities (i.e. eye or ear trouble, back pain, allergies, or eating disorders) or disabilities you may suffer from. No, I don t have a medical condition if yes, please specify: I hereby declare that I am not suffering from any illness or disability, apart from those specified above and fully understand that a false statement will result in my dismissal from the program. Abusive use of alcohol will result in my dismissal from the program. Sexual involvement with a minor is considered a criminal offense and is punishable by law. Involvement with a minor will result in dismissal from the program. Leaving my appointed host, if I have not received the approval of CAEP Brasil, will result in dismissal from the program. Also, I understand that my visa will be canceled and CAEP Brasil will have no further obligations. Possession and/or use of drugs, other than those recommended or prescribed by doctor will result in my dismissal from the program. Training Visas are only granted to me on the condition that: Have not previously entered Brazil in VITEM-I Visa status as a participant in an exchange program. I stay with my appointed host and I will leave Brazil upon completion/termination of my program. I agree to pay the CAEP Brasil U$ Program fee. I, the undersigned, agree to maintain adequate health insurance coverage, as defined by Brazilian Government during my entire stay in Brazil and pay all fees for insurance purchased through CAEP Brasil. I the undersigned understand that U$ is due if I cancel my program or if I am denied the VITEM-I at a Brazilian Consulate/Embassy prior to the arrival in Brazil. I the undersigned understand that if I am dismissed from the program, I will be required to leave my host country immediately, and return transportation will be my own responsibility. I agree to relieve CAEP Brasil of all the costs incurred. I declare that I have read and understood the conditions listed above, and that I will comply with them accordingly. I declare that the information given in this application is accurate and complete. This Declaration must be completed, signed and dated by all CAEP Brasil applicants. Signature of Applicant Date: / / Day Month Year PLEASE PRINT, COMPLETE, SIGN AND SCAN THIS APPLICATION, INCLUDING ALL REQUIRED DOCUMENTS AND SEND IT BY INFO@CAEP.COM.BR OR BY POSTAL ADDRESS: CAEP BRASIL - AV. PAULISTA, 1471 CONJ CEP SÃO PAULO, SP BRAZIL.