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BOLLETTINO UFFICIALE
DELLA REGIONE AUTONOMA VALLE D’AOSTA
BULLETIN OFFICIEL
DE LA RÉGION AUTONOME VALLÉE D’AOSTE
Aosta, 29 novembre 2016
Aoste, le 29 novembre 2016
DIREZIONE, REDAZIONE E AMMINISTRAZIONE:
DIRECTION, RÉDACTION ET ADMINISTRATION :
Presidenza della Regione - Affari legislativi
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Allegato G
DOMANDA DI PARTECIPAZIONE ALLA ASSEGNAZIONE DEGLI
AMBITI TERRITORIALI CARENTI DI PEDIATRIA DI LIBERA SCELTA
- per trasferimento ALL’AZIENDA U.S.L. VALLE D’AOSTA
Direzione Area Territoriale
Ufficio Convenzioni Nazionali Uniche
VIA GUIDO REY, 1
11100 AOSTA AO
Il/La sottoscritto/a Dott. ___________________________________________________________
nato/a a ______________________________prov. (_________) il ______________________
M
F
codice fiscale____________________________________________________
residente a _______________________________________________________ prov. _______
Via ________________________________________________________ n. _________
Cap. _____________ a far data dal______________________________ , residente nel
territorio della Regione ___________________________________ dal _____________________
Tel. ______________________________ Cell. _______________________________
titolare di incarico a tempo indeterminato per la pediatria di libera scelta presso l’Azienda
USL di _____________________ della Regione ______________________ dal ______________
e con anzianità complessiva di pediatria di libera scelta pari a mesi ________________
FA DOMANDA DI TRASFERIMENTO
secondo quanto previsto dall’Accordo Collettivo Nazionale vigente, per l’assegnazione degli ambiti
territoriali carenti di pediatria di libera scelta pubblicati sul B.U.R. della Regione autonoma Valle
d’Aosta n.__________ del ________________:
N.
DISTRETTO
N. AMBITO
TERRITORIALE
COMUNI AMBITO TERRITORIALE
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N. 52
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segue Allegato G
Indicare eventuale recapito diverso dalla residenza per ogni comunicazione da parte dell’ufficio:
____________________________________________________________________________
____________________________________________________________________________
____________________________
data
_______________________________
firma per esteso (*)
1) Indicare espressamente il Distretto e l’Ambito Territoriale per i quali si intende concorrere. Se le
righe non fossero sufficienti compilare e allegare un foglio a parte.
(*) In luogo dell’autenticazione della firma, allegare fotocopia semplice di un documento di identità.
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N. 52
29 - 11 - 2016
AVVERTENZE GENERALI
La domanda di trasferimento negli ambiti territoriali carenti di pediatria di libera scelta dovrà essere
spedita a mezzo Raccomandata o PEC ([email protected]), all’Azienda U.S.L. Valle D’Aosta
– Direzione Area Territoriale - Via Guido Rey n. 1 – 11100 AOSTA, entro e non oltre 15 giorni dalla
pubblicazione sul B.U.R. del presente avviso.
Possono concorrere al conferimento degli incarichi negli ambiti territoriali carenti resi pubblici secondo
quanto stabilito dal comma 1:
- i pediatri che risultano già iscritti in uno degli elenchi dei pediatri convenzionati per la pediatria di
famiglia della Regione che ha pubblicato gli ambiti territoriali carenti a condizione che risultino
iscritti da almeno tre anni e che al momento dell’attribuzione del nuovo incarico non svolgano altre
attività a qualsiasi titolo nell’ambito del Servizio Sanitario Nazionale, eccezion fatta per attività di
continuità assistenziale;
- i pediatri che risultano già iscritti in un elenco di pediatria di altra Regione a condizione che risultino
iscritti da almeno cinque anni e che al momento dell’attribuzione del nuovo incarico non svolgano
altre attività a qualsiasi titolo nell’ambito del Servizio Sanitario Nazionale, eccezion fatta per attività
di continuità assistenziale
Si evidenzia che gli interessati dovranno inviare un’unica domanda, conforme allo schema allegato,
disponibile presso la Direzione di Area Territoriale dell’U.S.L. di Aosta.
Si raccomanda di scrivere in stampatello.
La mancata presentazione, entro il termine che sarà indicato nella convocazione formale, sarà
considerata a tutti gli effetti come rinuncia all’incarico.
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N. 52
29 - 11 - 2016
Allegato H
DOMANDA DI PARTECIPAZIONE ALLA ASSEGNAZIONE DEGLI
AMBITI TERRITORIALI CARENTI DI PEDIATRIA DI LIBERA SCELTA
- per graduatoria ALL’AZIENDA U.S.L. VALLE D’AOSTA
Direzione Area Territoriale
Ufficio Convenzioni Nazionali Uniche
VIA GUIDO REY, 1
11100 AOSTA AO
Il/La sottoscritto/a Dott. _________________________________________________________
nato/a a ______________________________prov. (_________) il ______________________
M
F
codice fiscale____________________________________________________
residente a _____________________________prov. _______Via ________________________
n. _________ Cap. _____________ Tel. _________________ Cell. ______________________
iscritto nella vigente graduatoria unica regionale della Regione autonoma Valle d’Aosta valevole per il
periodo: 01/01/201 – 31/12/201
posizione n. __________ punteggio n. _____________
FA DOMANDA
secondo quanto previsto dal vigente A.C.N. per la disciplina dei rapporti con i medici specialisti pediatri
di libera scelta, per l’assegnazione degli ambiti territoriali carenti di pediatria di libera scelta
sottoelencati e pubblicati sul B.U.R. della Regione autonoma Valle d’Aosta n.______ del
_____________ :
N.
N.
AMBITO
DISTRETTO TERRITORIALE
COMUNI
AMBITO TERRITORIALE
N.
POSTI
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N. 52
29 - 11 - 2016
segue Allegato H
A tal fine, ai sensi dell’art. 46 del D.P.R. 28.12.2000, n. 445, sotto la propria responsabilità,
consapevole di quanto stabilito dall’art. 76 dello stesso D.P.R.445/2000 in caso di dichiarazione
mendaci, dichiara:
di essere residente nel Comune di ___________________________________ prov. _________,
a decorrere dal ___________/ ___________/________________
giorno
mese
anno
Qualora la residenza attuale sia stata acquisita successivamente al ________________
dichiara, inoltre:
di essere stato residente alla data del _______________ e fino al ______/_______/_________/
nel Comune di ________________________________
*****
Indicare eventuale recapito diverso dalla residenza per ogni comunicazione da parte dell’ufficio:
___________________________________________________
___________________________________________________
____________________
data
_______________________________
firma per esteso (*)
Indicare espressamente il Distretto e l’Ambito Territoriale per i quali si intende concorrere. Se le righe
non fossero sufficienti compilare e allegare un foglio a parte.
(*) In luogo dell’autenticazione della firma, allegare fotocopia semplice di un documento di identità.
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N. 52
29 - 11 - 2016
segue Allegato H
AVVERTENZE GENERALI
La domanda di inserimento negli ambiti territoriali carenti di pediatria di libera scelta dovrà essere
spedita a mezzo Raccomandata, all’Azienda U.S.L. Valle D’Aosta – Direzione Area Territoriale - Via
Guido Rey n. 1 – 11100 AOSTA, entro e non oltre 15 giorni dalla pubblicazione nel B.U.R. del
presente avviso.
Possono presentare domanda di inserimento i medici inclusi nella vigente graduatoria unica regionale
valevole per il periodo: 01/01/2016 – 31/12/2016.
Si evidenzia che gli interessati dovranno inviare un’unica domanda, conforme allo schema allegato, alla
Direzione di Area Territoriale dell’U.S.L. di Aosta. Si raccomanda di scrivere in stampatello.
Alla domanda di inserimento va allegato il certificato di residenza con indicazione della data di
acquisizione della stessa (giorno, mese, anno) ovvero, ai sensi dell’art. 46 del “T.U. delle disposizioni
legislative e regolamentari in materia di documentazione amministrativa” di cui al D.P.R. 445 del
28.12.2000, la dichiarazione sostitutiva attestante il possesso della residenza sempre con indicazione
della data di acquisizione.
In caso di mancata indicazione della data di acquisizione della residenza, non saranno attribuiti i
punteggi connessi al possesso della residenza.
ATTENZIONE:in caso di dichiarazioni mendaci si incorre in responsabilità penalmente sanzionabili
(art. 76 del D.P.R. 445/2000).
Si precisa che i 6 punti per la residenza nella “località carente” previsti dall’art. 33, comma 3, lettera b)
dell’A.C.N. 2396/2005 saranno attribuiti a coloro che abbiano la residenza in uno dei Comuni
dell’ambito territoriale, ove viene pubblicata la zona carente, da almeno due anni antecedenti la
scadenza del termine per la presentazione delle domande di inclusione nella graduatoria regionale.
Lo stesso termine vale per l’attribuzione dei 10 punti per la residenza nella Regione Valle d’Aosta
previsti dall’art. 33, comma 3, lettera c) dell’A.C.N. per la disciplina dei rapporti con i medici specialisti
pediatri di libera scelta, reso esecutivo in data 15 dicembre 2005 mediante intesa n. 2396 nella
Conferenza Stato/Regioni.
Ai sensi del sopracitato art. 33, il requisito che dà diritto al punteggio per la residenza deve essere
mantenuto fino all’attribuzione dell’incarico.
La mancata presentazione, entro il termine che sarà indicato nella convocazione formale, sarà
considerata a tutti gli effetti come rinuncia all’incarico.
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N. 52
29 - 11 - 2016
ANNEXE G
ACTE DE CANDIDATURE
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N. 52
29 - 11 - 2016
INFORMATIONS GÉNÉRALES
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29 - 11 - 2016
ANNEXE H
ACTE DE CANDIDATURE
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INFORMATIONS GÉNÉRALES
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