Formulário Geral de Aplicação de Estágio General Trainee

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Formulário Geral de Aplicação de Estágio General Trainee
CAEP Brasil Intercâmbio
CNPJ 04.869.542/0001-56
Av. Paulista, 1471 – Conj.1503
CEP 01311-927 – São Paulo, SP – Brasil
Telefone/Fax: + 55 (11) 3262-0010
E-mail: [email protected]
Site: www.caep.com.br
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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
2.
Nome do meio / Middle
Masculino / Male
Feminino / Female
Nome / First Name
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
E-mail: [email protected] ___________________ 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: _______________________________ E-mail: [email protected]___________________
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
3
4
5
6
7
8
9
10
11
12
Meses / Months
Data de início / starting date ________/ _____________/ ____________ (dia / mês / ano – day / month / year)
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
D)
Laboratório / Laboratory
EQUINOS / EQUINE
Competição; Lazer / Competition; Pleasure
Reprodução / Breeding
Veterinária / Veterinary
Rancho / Western
E)
Viticultura / Viticulture
Corrida / Racing
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:
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
Não / No
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
Não / No
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
Não / No
c) Você já teve algum tipo de visto ao Brasil negado? / Have you been denied any type of visa to Brazil?
Não / No
Sim, um visto de ______________ / Yes, a _____________visa (type of visa)
Você já esteve no Brasil? / Have you been in Brazil before?
Não / No
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
Ruim /
Poor
Regular /
Fair
Bom /
Good
Excelente /
Excellent
Compreensão Português / Understanding Portuguese
Ruim /
Poor
Regular /
Fair
Bom /
Good
Excelente /
Excellent
Leitura Português / Reading Portuguese
Ruim /
Poor
Regular /
Fair
Bom /
Good
Excelente /
Excellent
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
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
Não / No (É obrigatória a carteira internacional antes de sua chegada / You must have an International driver’s license before arrival)
Carro / Car
Empilhadeira / Forklift
j) Fumante / Smoke:
Sim / Yes
k) Ingere álcool? / Drink alcohol?
l) Estado civil / Marital status:
Caminhão / Commercial truck license
Outros / Other: ____________
Não / No
Sim, com moderação / Yes, in moderation
Não / No
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
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$550.00 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$200.00 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 E-MAIL: [email protected] OR BY POSTAL ADDRESS:
CAEP BRASIL - AV. PAULISTA, 1471 – CONJ. 1503 - CEP 01311-927 – SÃO PAULO, SP – BRAZIL.

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