ࡱ> '` ,bjbjVwVw 1D44N9HHHXhhhT'''|(H,8|`0FFFFI .IBI [z]z]z]z]z]z]z~hr]zhKHH"KK]zhhFF {YYYKhFhF[zYK[zYYV_b@hh#cF0 Ƨd'Rb wd|08|bxrSr#c#crh7c@NII|YxJdJNININI]z]z=Y^NININI8|KKKKd Ď hhhhhh Application FormDossier de candidatureof (de)  FORMTEXT      Master in Managementof theConservatoire National des Arts et Metiers Cnam  Ecole MS  Dept MIP  Case 1D3P40  Programme MIM 2 rue Cont, 75141 Paris Cedex 03, France telephone: +33 1 58 80 87 49 fax: +33 1 58 80 87 50 (Attention to: Mrs Tra NGUYEN) ChecklistListe des pices fournirApplication for admission to the CNAMMIM Master in Management requires the following documentsLe dossier de candidature au programme Master du CNAMMIM exige les documents suivantsOne copy of this application form accompanied by two (2) photographs, 1 photo by electronic versionUn exemplaire de votre dossier dinscription accompagn de 2 photos didentit et 1 photo numrique  FORMCHECKBOX One copy of your passport (page with personal information and photo)Copie de la page dinformation de votre passeport  FORMCHECKBOX An official copy of your post-secondary degree certificate(s) Copie conforme du baccalaurat ou diplme quivalent  FORMCHECKBOX An official transcript of all post-secondary education Copie conforme des diplmes obtenus lors du cursus universitaire  FORMCHECKBOX Evidence of English language proficiency Preuve de capacit en anglais comme langue trangre FORMCHECKBOX Note2 letters of reference which conform to CNAMMIM guidelines 2 lettres de rfrence conformes au modle CNAMMIM FORMCHECKBOX NoteIf your application is being supported by your current employers, the Employer Sponsorship formEn cas de prise en charge par votre employeur actuel, le formulaire Participation de lemployeur  FORMCHECKBOX  A non-refundable application fee of Euros 125 either by cheque or by bank transfer with the bank details Frais de dossier non rembourss Euros 125 par chque ou virement bancaire  FORMCHECKBOX One electronic version (scanned type) of all above application forms & documents and one electronic photograph, in the format of JPG (less than 300KB each documents)  FORMCHECKBOX CNAM BANK DETAILSBeneficiarys NameTitulaire du compteRAR Ecole Management et SocieteBeneficiarys Address(Postal address)Site Saint Martin, 292 rue Saint Martin, 75141 Paris Cedex 03, FranceBeneficiarys A/CRIBFR 76 1007 1750 0000 0010 0418 247Beneficiarys Bank name TP PARIS or Banque de FranceBeneficiarys Bank addressRecette Gnrale des Finances de Paris 94, rue Reaumur, 75104, Paris cedex 02S.W.I.F.T. BICTRPUFRP1Beneficiarys NameTitulaire du compteRAR Ecole Management et SocieteBeneficiarys Address(Postal address)Site Saint Martin, 292 rue Saint Martin, 75141 Paris Cedex 03, FrancePlease be attention that all the fees of bank transfer (senders & receivers fees) are at students charge. (Choosing M1 + one of options in M2 or choosing only one option of M2 if you are qualified to enter directly to M2) FORMCHECKBOX M1 Master 1 Core curriculum FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX M21 - Major in Project Management & Business EngineeringMR079p2M22 - Major in Sustainable Development & Global Quality ManagementMR080p2M23 - Major in International Business & Corporate DevelopmentMR072p2M24 - Major in Organization Consulting & Change Management(MR087p1  in French)Surname/Family name  FORMTEXT      NomAttach a photograph of yourselfAfficher une photo d identitFirst name  FORMTEXT      PrnomGenderSexe  FORMCHECKBOX  Male " Masculin FORMCHECKBOX  Female " FmininNationality  FORMTEXT      Nationalit Civil status  FORMTEXT      Situation de famille# children  FORMTEXT   Nb enfantsPersonal address Addresse personnelle  FORMTEXT      Postal code  FORMTEXT      Code postalCity  FORMTEXT      VilleTelephone  FORMTEXT      TlephoneCountry  FORMTEXT      PaysEmail  FORMTEXT      Fax  FORMTEXT      Date of birth (dd-mm-yyyy)  FORMTEXT      Date de naissance (jj-mm-aaaa)Place of birth (as written in the passport)  FORMTEXT      Lieu de naissanceContact in emergencyContact en cas d urgence  FORMTEXT      Telephone  FORMTEXT      TlphoneCountry  FORMTEXT      Pays Educationtudes Undergraduate education (higher education leading to the Bachelor s degree)tudes suprieures University Etablissementfromdeto Major SpecialitDegree Diplme Graduation date Obtenu le 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      Graduate education (higher education leading to the Master s or Doctoral degree)tudes suprieures University Etablissementfrom detoMajor SpecialitDegree Diplme Graduation date Obtenu le FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT      IELTS, GMAT, TOEFL or equivalentDateLocation " Lieu Score " Rsultat  FORMTEXT       FORMTEXT       FORMTEXT      English language certifications Comptences en anglais comme langue trangreCertification " Diplme DateScore " Rsultat FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       LanguagesLanguesLanguage LangueVerbal fluency Expression oraleWritten fluencyExpression ecrite FORMTEXT       FORMCHECKBOX Fluent Courrant  FORMCHECKBOX Intermediate Intermdiaire  FORMCHECKBOX BasicBases FORMCHECKBOX Fluent Courrant  FORMCHECKBOX Intermediate Intermediaire  FORMCHECKBOX BasicBases FORMTEXT       FORMCHECKBOX Fluent Courrant  FORMCHECKBOX Intermediate Intermdiaire  FORMCHECKBOX BasicBases FORMCHECKBOX Fluent Courrant  FORMCHECKBOX Intermediate Intermediaire FORMCHECKBOX BasicBases FORMTEXT       FORMCHECKBOX Fluent Courrant  FORMCHECKBOX Intermediate Intermdiaire  FORMCHECKBOX BasicBases FORMCHECKBOX Fluent Courrant  FORMCHECKBOX Intermediate Intermediare  FORMCHECKBOX BasicBases FORMTEXT       FORMCHECKBOX Fluent Courrant  FORMCHECKBOX Intermediate Intermdiaire  FORMCHECKBOX BasicBases FORMCHECKBOX Fluent Courrant  FORMCHECKBOX Intermediate Intermediaire  FORMCHECKBOX BasicBasesPrizes, scholarships, distinctionsPrix, bourses, distinctions FORMTEXT      Military serviceService militaire FORMTEXT      Professional or other certificationsAutres formations professionnelles ou diplmantes FORMTEXT       FORMCHECKBOX  Other & Autre &  Work experienceExpriences professionnellesCurrent employer  FORMTEXT      Employeur actuelSince  FORMTEXT      DepuisJob title  FORMTEXT      PosteEmployment addressAdresse professionnelle  FORMTEXT      Telephone  FORMTEXT      TlphonePosition description  FORMTEXT      Descriptif de poste Major responsibilities  FORMTEXT      Previous employment Emploi prcedentEmployer " EmployeurLocation " LieuPosition " Postefrom " deto "  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      EssayDissertationRespond to the four (4) questions that follow in 300 words or less.What are your career goals over the next 5 years, and what role will this Master play in achieving them? FORMTEXT      Describe and analyze one (1) key business, or personal, or life achievement. FORMTEXT      Describe and analyze one (1) key business, or personal, or life failure you have experienced. FORMTEXT       Describe and analyze one (1) important leadership event you have experienced. FORMTEXT       How did you learn about the CNAM-MIM Master in Management?Comment avez-vous connu le Master du CNAM-MIM? FORMCHECKBOX  Printed material  FORMCHECKBOX  email FORMCHECKBOX  CNAM-MIM web site FORMCHECKBOX  Internet search FORMCHECKBOX  Word of mouth FORMCHECKBOX  employer FORMCHECKBOX  friendOther:Autre: FORMTEXT      DeclarationDclarationAll information given in this application is accurate and truthful to the best of my knowledge.Je certifie que toutes les informations fournies dans ce document sont exactes et sincres.Details of my educational qualifications and work experience may be checked by CNAMIIM with the organisations and authorities concerned.Le CNAMIIM pourra demander auprs des organisations et autorits concernes tout detail utile concernant les tudes suprieures ou les rfrences professionnelles du candidat(e).I hereby apply for admission to the Master in Management program of the CNAMIIM. If admitted to the program, I agree to obey all statutes and regulations of CNAM-MIM.Je demande par la prsente mon admission dans le programme Master du CNAM IIM et, si je suis admis, je m engage respecter toute l organisation et tous les rglements du CNAM IIM.Signature FORMTEXT      Date FORMTEXT      Place " Lieu FORMTEXT       Reference formFormulaire de recommandationName of candidate  FORMTEXT      Nom du candidat(e)The individual named above has applied for admission to the CNAM IIM Master in Management program. We will appreciate your completing this reference form and returning it to CNAM  IIM/ MIM, Cas 1D3P40, 2 rue Cont, 75003 Paris, France or sending it as attachment to  HYPERLINK "mailto:tra.nguyen@cnam.fr" tra.nguyen@cnam.fr Le candidat(e) susnomm a demand son admission dans le programme Master du CNAMIIM. Nous apprcierions que vous acceptiez de complter ce document dapprciation et que vous le retourniez au CNAM MIM, 2 rue Cont, 75003 Paris, France ou lenvoyiez  HYPERLINK "mailto:tra.nguyen@cnam.fr" tra.nguyen@cnam.frIn what capacity have you known the candidate, and for how long?Dans quelles conditions avez- vous connu le/la candidat(e) et depuis quand? FORMTEXT      What are this person s strongest characteristics?Quelles sont les principales qualits du candidat(e)? FORMTEXT      What are this person s three characteristics in greatest need of development?Quels sont les domaines dans lesquels le/la candidat(e) devra s amliorer?  FORMTEXT      What circumstances might affect the candidate s ability to complete the CNAM-MIM Master?Y-a-t il des facteurs susceptibles de compromettre l aptitude du candidat(e) intgrer le Master du CNAM IIM? FORMTEXT      Please rate this candidate on the characteristics indicated belowSuperior Excllent Top 5%Very goodTrs bonTop 15%GoodBonTop 30%FairMoyenMid rangePoorMdiocreLower %No opinion Sans avisIntegrityIntgrit FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX Intellectual abilityCapacit intellectuelle  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX Intellectual breadthChamps de connaissances  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX Mathematical abilityCapacit mathmatique  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX Written communicationCommunication crite  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX Oral communicationCommunication orale  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX CreativityCrativit  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX Self-management  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX Motivation FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX MaturityMaturit  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX Ability to adapt to a foreign cultureCapacit sadapter une culture trangre  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX Perseverance  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX Self-confidenceConfiance en soi  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX Ability to work with others"NPRT`bvxzóuaFu%uAjh$h$5>*CJOJPJQJU^JaJmHnHo(u5jh h5>*CJOJQJU^JaJ&h$h$5>*CJOJQJ^JaJ/jh$h$5>*CJOJQJU^JaJ%h$B*CJ0\]aJ0mH phsH %h$h$5CJ0\]aJ0mH sH h$5CJ0\]aJ0mH sH %h*PB*CJ0\]aJ0mH phsH +h$h*PB*CJ0\]aJ0mH phsH %h$h*P5CJ0\]aJ0mH sH  "P( $$Ifa$gdvb$$Ifa$gdvb8kdj$$IfTY . 6a.T$h$Ifa$gdvb $$Ifa$gdvb$a$gd*Pgd*P*& ( * ^ n z Ǻuf\R\RH@7/hIh*P\h*P\mH sH h*PmH sH h*PCJmH sH hnCJmH sH hICJmH sH h*P5CJ"\aJ"mH sH  h*P5@CJH\aJHmH sH h*P5CJH\aJHmH sH h*PCJ\aJmH sH h*P5CJ"\aJ"h*P5@CJ(\aJ(h*P5@ CJ\aJ"h$h*P5CJ\aJmH sH h$h*PCJaJmH sH .h$h$5B*CJ0\]aJ0mH phsH ( * S T U _ z { umd[ $Ifgd!?J $Ifgdvb$a$gd*P6kd.$$IfT. 6a.T $$Ifa$gdvb$$Ifa$gdvb8kd$$IfT@ . 6a.T    2 R S T U y z |   2 3 4 e h j k x z ̷znzbVRNRNRJh!?Jh> 1h*Ph*PCJaJmH sH h*PCJHaJHmH sH hIB*mH phsH h*PB*mH phsH h*P5B*ph hI5 h*P5"h*Ph*P5CJ\aJmH sH h!?Jh*PmH sH h*Ph*PmH sH hIh*P5\hIh*P5CJ\aJ hIhI hIh| hIh*PhIh*P\hIhn\{ | 3 4 G2 & F(($IfgdvbEkd$$Ifl%]& t644 layt $$Ifa$gdvb$(($Ifa$gdvbUkd$$Ifl0f#%# t644 laz     V _ ȸwsdUJ?hhmH sH hh> 1mH sH hhB*mH phsH hh> 1B*mH phsH h> 1h*PCJaJhvbCJaJjIh+WQUhvbjhvbUhp?hvbmH sH hp?h*PCJaJmH sH h*PB*CJaJmH phsH h.B*mH phsH hIB*mH phsH h*PB*mH phsH hp?B*mH phsH h*Ph.   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$Ifgdvb`kd&$$Ifl%U&04 laHHIIBDFbdfhjl "$&ŽŲŽŠŽŎŽŃŽxŽmjh@ Uj5h@ Uj h@ UjM h@ U h;sh@ j h@ U h|Qh@ je h@ Ujh@ Uh@ h8uh@ CJaJmH sH %h8uh@ B*CJaJmH phsH Uh@ CJaJh$\h@ CJaJ)Capacit travailler en quipe  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX Name of referee  FORMTEXT      Nom du rfrent Degrees held / institution(s)  FORMTEXT      Diplmes obtenus / institution(s) Position and addressPoste et adresse  FORMTEXT      Telephone  FORMTEXT      Fax  FORMTEXT      Email  FORMTEXT      Signature FORMTEXT      Date  FORMTEXT       Reference formFormulaire de recommandationName of candidate  FORMTEXT      Nom du candidat(e)The individual named above has applied for admission to the CNAM IIM Master in Management program. We will appreciate your completing this reference form and returning it to CNAM  IIM/ MIM, Cas 1D3P40, 2 rue Cont, 75003 Paris, France or sending it as attachment to  HYPERLINK "mailto:tra.nguyen@cnam.fr" tra.nguyen@cnam.fr Le candidat(e) susnomm a demand son admission dans le programme Master du CNAM IIM. Nous apprcierions que vous acceptiez de complter ce document d apprciation et que vous le retourniez au CNAM  MIM, 2 rue Cont, 75003 Paris, France ou l envoyiez  HYPERLINK "mailto:tra.nguyen@cnam.fr" tra.nguyen@cnam.fr In what capacity have you known the candidate, and for how long?Dans quelles conditions avez- vous connu le/la candidat(e) et depuis quand? FORMTEXT      What are this person s strongest characteristics?Quelles sont les principales qualits du candidat(e)? FORMTEXT      What are this person s three characteristics in greatest need of development?Quels sont les domaines dans lesquels le/la candidat(e) devra s amliorer?  FORMTEXT      What circumstances might affect the candidate s ability to complete the CNAM-MIM Master?Y-a-t il des facteurs susceptibles de compromettre l aptitude du candidat(e) intgrer le Master du CNAM IIM? FORMTEXT      Please rate this candidate on the characteristics indicated belowSuperior Excllent Top 5%Very goodTrs bonTop 15%GoodBonTop 30%FairMoyenMid rangePoorMdiocreLower %No opinion Sans avisIntegrityIntgrit FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX Intellectual abilityCapacit intellectuelle  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX Intellectual breadthChamps de connaissances  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX Mathematical abilityCapacit mathmatique  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX Written communicationCommunication crite  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX Oral communicationCommunication orale  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX CreativityCrativit  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX Self-management  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX Motivation FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX MaturityMaturit  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX Ability to adapt to a foreign cultureCapacit s adapter une culture trangre  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX Perseverance  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX Self-confidenceConfiance en soi  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX Ability to work with othersCapacit travailler en quipe  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX Name of referee  FORMTEXT      Nom du rfrent Degrees held / institution(s)  FORMTEXT      Diplmes obtenus / institution(s) Position and addressPoste et adresse  FORMTEXT      Telephone  FORMTEXT      Fax  FORMTEXT      Email  FORMTEXT      Signature FORMTEXT      Date  FORMTEXT      Employer sponsorship formParticipation de l employeurName of candidate  FORMTEXT      Nom du candidat(e)Organisation  FORMTEXT      EmployeurAddress  FORMTEXT      Name of direct supervisorNom du responsable hirarchique FORMTEXT      Name of individual completing this formNom de la personne ayant rempli le formulaite FORMTEXT      Telephone FORMTEXT      Fax FORMTEXT      Email FORMTEXT      Telephone FORMTEXT      Fax FORMTEXT      Email FORMTEXT      Please highlight the candidate s current responsibilities.Indiquez, svp, les responsabilits actuelles du candidat(e). FORMTEXT      Please briefly assess the candidate s career potential.Votre avis sur les potentialits de carrire du candidat(e). FORMTEXT      Please outline this organization s plan for the candidate s career development.Quel est le plan de dveloppement de carrire prvu pour le candidat(e) dans l entreprise? FORMTEXT      To support the candidate s development, please indicate areas / issues on which this program should focus.Afin de rpondre aux besoins du candidat(e) dans l objectif de son dveloppement, prire de nous indiquer les points importants appuyer durant le programme. FORMTEXT      Will this organization support the candidate in some way (financially or otherwise)?L employeur soutiendra-t-il le candidat(e) et de quelle manire (financirement ou autre)? FORMCHECKBOX YesOui FORMCHECKBOX NoNonIf yes, in what way and to what extent?Si oui, comment et dans quelle mesure? FORMTEXT      Signature FORMTEXT      Date FORMTEXT       A high level of English fluency is required. If English is not your mother tongue, you will be asked to submit results from the TOEFL, the Test of English as a Foreign Language, or another internationally recognized certification of English language competence that is accepted by the CNAM IIM. (IELTS, GMAT, etc.) Check with an official representative for details. Letters of reference should make use of the CNAM IIM form supplied for this purpose, and may be accompanied by a personal letter from your referee. 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