Application Form

15th 24th March 2016, Rijeka, Croatia

Send the filled-in application form to your sending organization and also to

mynextjobexchange@synergy-croatia.com
All information gathered in this form will be kept strictly confidential and used only for the purposes
of the youth exchange.

PERSONAL INFORMATION
First name:

Cornelia Adriana

Last name:

Chelaru

Name you want to be called in

the training :
(that will appear on your name
tag)
Address (street):

Adriana

Zip code:

617136

City:

Roman

Country:

Romania

ID/Passport Number:

Linistei, 4

NT 520310

Citizenship:

Romanian

E-mail:

adri.ana02@yahoo.com

Phone number:

0040742911692

Date of birth:

02.02.1989

Place of birth:

Roman, Romania

Do you have the European

Health Insurance Card?
Your age at the beginning of the
training:
Gender:

Yes
27
Female

Name of the sending

organization:
Your role in the organization:
Contact person in case of Iosif Ciprian
emergency Name:
Address: Linistei, 4

Phone number: 0040767444600

Relation to you: Brother
Level of English (excellent,
good, medium, basic):
How did you hear about the
project
Are you appling as team
member/group leader?
If yes describe which kind of
experiences do you have with
basic synergy trainings

Medium
My best friend Cosmina
No

PLEASE INDICATE IF YOU FACE FOLLOWING CONDITIONS:

Are you facing economic
difficulties (low income,
dependence on social-welfare,
long- term unemployment)?
Did/do you have any
educational problems (e.g.
dropouts?)
Are you facing social obstacles?
(coming from broken families,
from foster homes, sexual
orientation minority)
Do you experience any cultural
differences (national or ethnical
minorities, descendants of
immigrants)
Do you face geographical
obstacles (e.g. living isolated?)

Yes
No

No

No
No

MOTIVATION
How does the theme of the
project relate to your life?
(min. 50 words)

Participating on this project will give me the opportunity to

adapt more rapidly with people around me and to carry out
the ideas, to accept different people from different cultures
and in the same time to see exactly how can I face the
market work on a larger scale, plus many other experiences
that not necessarily related to specific technical areas but
more human interaction.

What is your motivation to

participate in this project?
(min. 50 words)

I am very excited about this opportunity because I know I

will get to know new people, different cultures and lastly I
will develop practical skills that will help me to succeed on
my next job.
Honestly, my friend Cosmina was always organizing in
Croatia this kinds of training and I was curious to see what
is about since I am interested about my personal and
professional development.

What do you expect to learn

during this course?
(min. 50 words)

To gain a lot of useful information which I will use it in the

future and develop communication skills.
To learn how to be more open on the first side when
meeting new people
Learn how to adapt, gain more courage and initiative.

How do you plan to use what

you learn when you go back
home and how would you
spread the results of the
exchange?
(min. 50 words)
Describe your dream job?

The first thing I will do will be to put into practice what I will
learn in this period of the project and to encourage other
people to apply for this trainings. I think I will gain a lot of
inspiration during the project which will allow me to answer
this question

If you were the CEO of your own

NGO/company what would your
organization be doing?

I'd organize a lot of trainings/internship for students who

wish to acquire experience in the field of the desired
activity.

My dream job is to work as a programmer on the web after

you accumulate experience I'd like to get every side of Java.

HEALTH CONDITION
Do you have a valid medical
insurance for Croatia?

Yes. I have a medical insurance in Italy, I think its valid in

every state in the European Union.

In case you are selected as a participant in this youth exchange, you will be
asked to have a valid medical insurance for your stay in Croatia!
What is your present health
status?

Very good

Do you have any disabilities

(mental/physical)? Please
describe your condition.

No, I am very healthy in all.

Do you have any allergies? If

yes, please specify.

No

Do you require a special diet?

(Like vegetarian, no fish, no milk
etc.)

No

Do you take any medication?

What for? How often?

No

Did you have any serious

medical problems in the past?

No

I hereby declare that I have read the project info-letter, I understand the
conditions of reimbursement, and that all the above information provided
by me is true and correct to the best of my knowledge:

Date: 15.02.2016
Place: Romania
Signature: Adriana Chelaru

All information gathered in this form will be kept strictly confidential and used
only for the purposes of the youth exchange.