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[null,null,"UNIVERSIDAD DE LA REPÚBLICA"]
[]
[null,null,"FACULTAD DE ODONTOLOGÍA"]
[]
[null,null,"CURRICULUM VITAE - DECLARACION JURADA"]
[]
["A - DATOS PERSONALES"]
[]
["NOMBRE COMPLETO"]
[]
[]
["CEDULA DE IDENTIDAD",null,null,null,"DOMICILIO"]
[]
[]
["TELEFONO",null,null,null,"CELULAR",null,null,null,null,"CORREO ELECTRONICO (*)"]
[]
["* Dirección de correo electrónico que constituyo y que se considerará válida para todas notificaciones personales."]
[]
["CARGO MOTIVO DEL LLAMADO:"]
["DENOMINACION DEL CARGO - CÁTEDRA O SERVICIO",null,null,null,null,null,null,null,null,null,null,null,null,"GRADO",null,"NRO. LLAMADO"]
[]
[]
[]
["Art. 239 Código Penal: \"El que, con motivo del otorgamiento o formalización de un documento público, ante un funcionario público, prestare una declaración falsa sobre su identidad o estado, o cualquiera otra circunstancia de hecho, será castigado con tres a veinticuatro meses de prisión.\""]
[]
[]
[]
["Para completar el formulario se debe utilizar una versión de Excel 2007 en adelante. Ante la advertencia de seguridad, presione \"habilitar contenido\""]
[]
["Para insertar filas con formato presione el signo            "]
[]
[]
["B - RELACIÓN DE MÉRITOS Y ANTECEDENTES"]
[]
[null,"I – ESTUDIOS UNIVERSITARIOS"]
[]
[]
["I.1-TÍTULOS UNIVERSITARIOS DE GRADO:"]
["NOMBRE DEL TÍTULO",null,null,null,null,"HORAS DE LA FORMACIÓN CORRESPONDIENTE SEGÚN PLAN DE ESTUDIOS",null,null,null,"INSTITUCIÓN QUE OTORGA EL TÍTULO",null,null,null,"FECHA DE GRADUACIÓN",null,"PROMEDIO DE ESCOLARIDAD"]
[]
[]
[]
[]
[]
[]
["I.2-TÍTULOS UNIVERSITARIOS DE POSGRADO:"]
["NOMBRE DEL TÍTULO",null,null,null,null,"HORAS DE LA FORMACIÓN CORRESPONDIENTE SEGÚN PLAN DE ESTUDIOS",null,null,null,"INSTITUCIÓN QUE OTORGA EL TÍTULO",null,null,null,"FECHA DE GRADUACIÓN",null,"PROMEDIO DE ESCOLARIDAD"]
[]
[]
[]
[]
[]
[]
["I.3-COLABORADOR HONORARIO DE LA FACULTAD DE ODONTOLOGÍA:"]
["DE LA UNIDAD DOCENTE MOTIVO DEL LLAMADO",null,null,null,null,null,null,null,null,null,null,"DESDE:",null,null,"HASTA:"]
[]
["DE LA MATERIA (EXCEPTUANDO LA UNIDAD DOCENTE MOTIVO DEL LLAMADO)",null,null,null,null,null,null,null,null,null,null,"DESDE:",null,null,"HASTA:"]
[]
[]
[]
["I.4-AMPLIACIÓN DE CONOCIMIENTOS: "]
["DE LA UNIDAD DOCENTE MOTIVO DEL LLAMADO",null,null,null,null,null,null,null,null,null,null,"DESDE:",null,null,"HASTA:"]
[]
["DE LA MATERIA (EXCEPTUANDO LA UNIDAD DOCENTE MOTIVO DEL LLAMADO)",null,null,null,null,null,null,null,null,null,null,"DESDE:",null,null,"HASTA:"]
[]
[]
[]
[]
["I.5-CURSOS DE FORMACIÓN O PROFUNDIZACIÓN PEDAGÓGICA, FORMACIÓN O PROFUNDIZACIÓN EN INVESTIGACIÓN CIENTÍFICA, FORMACIÓN O PROFUNDIZACIÓN EN EXTENSIÓN, Y/O DE EDUCACIÓN PERMANENTE DE LA MATERIA:"]
[]
["NOMBRE DEL CURSO",null,null,null,null,null,null,null,"LUGAR",null,null,null,"CARGA HORARIA",null,null,"FECHA"]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
["I.6-CURSOS DE EDUCACIÓN PERMANENTE EN MATERIAS AFINES:"]
["NOMBRE DEL CURSO",null,null,null,null,null,null,null,"LUGAR",null,null,null,"CARGA HORARIA",null,null,"FECHA"]
[]
[]
[]
[]
[]
["I.7-CURSOS DE EDUCACIÓN PERMANENTE EN OTRAS MATERIAS:"]
["NOMBRE DEL CURSO",null,null,null,null,null,null,null,"LUGAR",null,null,null,"CARGA HORARIA",null,null,"FECHA"]
[]
[]
[]
[]
[]
[]
[null,"II - ENSEÑANZA"]
[]
[null,"II.A - CARGOS DOCENTES EN EFECTIVIDAD"]
[]
[]
["II.A.1-DESIGNACIÓN DIRECTA EN LA CÁTEDRA MOTIVO DEL LLAMADO:",null,null,null,null,null,null,null,null,null,null,"GRADO",null,"FECHA   "]
[]
[]
[]
["II.A.2-CONCURSOS APROBADOS EN LA CÁTEDRA MOTIVO DEL LLAMADO:"]
["II.A.2.1-Con obtención del cargo: ",null,null,null,null,"TIPO (A= Designación Directa/ B= Méritos/ C= Méritos y Pruebas/ D= Pruebas)",null,null,null,null,null,"GRADO",null,"FECHA",null,"PUNTAJE"]
[]
[]
[]
[]
["II.A.2.2-Sin obtención del cargo: ",null,null,null,null,"TIPO (A= Designación Directa/ B= Méritos/ C= Méritos y Pruebas/ D= Pruebas)",null,null,null,null,null,"GRADO",null,"FECHA",null,"PUNTAJE"]
[]
[]
[]
[]
[]
["II.A.3-CONCURSOS APROBADOS EN LA MATERIA MOTIVO DEL LLAMADO: "]
["II.A.3.1-Con obtención del cargo: ",null,null,null,null,"TIPO (A= Designación Directa/ B= Méritos/ C= Méritos y Pruebas/ D= Pruebas)",null,null,null,null,null,"GRADO",null,"FECHA",null,"PUNTAJE"]
[]
[]
[]
[]
["II.A.3.2-Sin obtención del cargo: ",null,null,null,null,"TIPO (A= Designación Directa/ B= Méritos/ C= Méritos y Pruebas/ D= Pruebas)",null,null,null,null,null,"GRADO",null,"FECHA",null,"PUNTAJE"]
[]
[]
[]
[]
[]
["II.A.4-CONCURSOS APROBADOS EN OTRAS MATERIAS: "]
["II.A.4.1-Con obtención del cargo: ",null,null,null,null,"TIPO (A= Designación Directa/ B= Méritos/ C= Méritos y Pruebas/ D= Pruebas)",null,null,null,null,null,"GRADO",null,"FECHA",null,"PUNTAJE"]
[]
[]
[]
[]
["II.A.4.2-Sin obtención del cargo: ",null,null,null,null,"TIPO (A= Designación Directa/ B= Méritos/ C= Méritos y Pruebas/ D= Pruebas)",null,null,null,null,null,"GRADO",null,"FECHA",null,"PUNTAJE"]
[]
[]
[]
[]
[]
["II.A.5-CONCURSOS APROBADOS EN LA MATERIA EN OTRAS FACULTADES DE LA UDELAR: "]
["II.A.5.1-Con obtención del cargo: ",null,null,null,null,"TIPO (A= Designación Directa/ B= Méritos/ C= Méritos y Pruebas/ D= Pruebas)",null,null,null,null,null,"GRADO",null,"FECHA",null,"PUNTAJE"]
[]
[]
[]
[]
[]
["II.A.5.2-Sin obtención del cargo: ",null,null,null,null,"TIPO (A= Designación Directa/ B= Méritos/ C= Méritos y Pruebas/ D= Pruebas)",null,null,null,null,null,"GRADO",null,"FECHA",null,"PUNTAJE"]
[]
[]
[]
[]
[]
[]
["II.A.6-CARGOS DOCENTES CONTRATADOS E INTERINOS OBTENIDOS POR LLAMADO \"ASPIRANTES\" EN LA CÁTEDRA\nMOTIVO DEL LLAMADO:"]
[]
["Nombre del Cargo:",null,null,null,null,"TIPO DE CONCURSO (méritos, méritos y pruebas, o pruebas)",null,null,null,null,null,"GRADO",null,"FECHA",null,"PUNTAJE"]
[]
[]
[]
[]
[]
[]
[]
[null,"II.B - DESEMPEÑO DE CARGOS DOCENTES "]
[]
["II.B.1-CARGOS DESEMPEÑADOS EN LA CÁTEDRA MOTIVO DEL LLAMADO:"]
["GRADO",null,"DESDE",null,"HASTA",null,"TIPO (efectivo, interino, contratado, honorario)"]
[]
[]
[]
[]
["II.B.2-CARGOS DESEMPEÑADOS EN LA MATERIA MOTIVO DEL LLAMADO: "]
["GRADO",null,"DESDE",null,"HASTA",null,"TIPO (efectivo, interino, contratado, honorario)"]
[]
[]
[]
[]
["II.B.3-CARGOS DESEMPEÑADOS EN OTRAS MATERIAS: "]
["NOMBRE DE LA MATERIA",null,null,null,"GRADO",null,"DESDE",null,null,"HASTA",null,"TIPO (idem anteriores)"]
[]
[]
[]
["II.B.4-CARGOS DESEMPEÑADOS EN LA MATERIA EN OTRAS FACULTADES DE LA UDELAR:"]
["FACULTAD",null,null,null,"GRADO",null,"DESDE",null,null,"HASTA",null,"TIPO (idem anteriores)"]
[]
[]
[]
[]
["II.B.5-CARGOS DESEMPEÑADOS EN LA MATERIA EN UNIVERSIDADES EN EL EXTERIOR"]
["Especificar y describir."]
[]
[]
[]
[]
["II.B.6-CARGOS DESEMPEÑADOS EN LA ESCUELA DE GRADUADOS EN CARRERAS DE ESPECIALIZACIÓN, MAESTRÍAS O POSGRADOS:"]
[]
["NOMBRE DE LA CARRERA, MAESTRÍA O DOCTORADO",null,null,null,null,null,null,null,null,null,"GRADO",null,"DESDE",null,"HASTA"]
[]
[]
[]
[]
["II.B.7-DESEMPEÑO DE ACTIVIDADES EN LA ESCUELA DE GRADUADOS EN CURSOS DE FORMACIÓN PERMANENTE:"]
["NOMBRE DEL CURSO",null,null,null,null,null,null,null,null,null,null,"CARGA HORARIA TOTAL DEDICADA"]
[]
[]
[]
[]
["II.B.8-DESEMPEÑO EN EL DICTADO DE CURSOS DE FORMACIÓN EN EDUCACIÓN, INVESTIGACIÓN, EXTENSIÓN Y/U OTROS:"]
["NOMBRE DEL CURSO",null,null,null,null,null,null,null,null,null,null,"CARGA HORARIA TOTAL DEDICADA"]
[]
[]
[]
[]
[null,"II.C - PROMOCIÓN Y EJECUCIÓN DE PROYECTOS DE\nDESARROLLO DE LA ENSEÑANZA"]
["II. C 1 PROYECTOS DE ENSEÑANZA EJECUTADO:"]
["NOMBRE DEL PROYECTO\n",null,null,null,null,null,null,null,null,null,"RESOLUCIÓN Y FECHA DE APROBACIÓN DEL INFORME FINAL\nPOR EL CONSEJO"]
[]
[]
[]
[]
[]
["II.C.2-PROYECTOS DE ENSEÑANZA EN EJECUCIÓN:"]
["NOMBRE DEL PROYECTO",null,null,null,null,null,null,null,null,null,"CONSTANCIA DE APROBACIÓN ACADÉMICA POR ORGANISMO COMPETENTE"]
[]
[]
[]
[]
[]
["II.C.3-PROYECTOS DE ENSEÑANZA CON APROBACIÓN ACADÉMICA NO EJECUTADO Y SIN FINANCIACIÓN:"]
["NOMBRE DEL PROYECTO",null,null,null,null,null,null,null,null,null,"CONSTANCIA DE APROBACIÓN ACADÉMICA POR ORGANISMO COMPETENTE"]
[]
[]
[]
[]
[]
[]
["II.C.4-ARBITRAJE Y EVALUACIÓN DE PROYECTOS DE ENSEÑANZA:"]
["Especificar y describir"]
[]
[]
[]
[]
[null,"III – ACTIVIDADES DE INVESTIGACIÓN CIENTÍFICA Y TECNOLÓGICA"]
[]
[]
["III.1-PROYECTOS DE INVESTIGACIÓN:"]
["III.1.1-Trabajo de investigación ejecutado pero no publicado"]
[]
[]
[]
[]
[]
["III.1.2-Proyecto de investigación en ejecución. "]
[]
[]
[]
[]
[]
["III.1.3-Proyectos con aprobación académica, no ejecutados y sin financiación"]
[]
[]
[]
[]
[]
["III.2","PUBLICACIONES CIENTÍFICAS"]
["III.2.1-Artículo de investigación publicado o aceptado para su publicación en revistas indexadas:"]
["NOMBRE DE LA REVISTA",null,null,null,null,null,null,null,null,"VOLÚMEN",null,"NÚMERO",null,"AÑO"]
[]
[]
[]
[]
[]
[]
[]
["III.2.2-Artículo de investigación publicado o aceptado para su publicación en revistas no indexadas:"]
["NOMBRE DE LA REVISTA",null,null,null,null,null,null,null,null,"VOLÚMEN",null,"NÚMERO",null,"AÑO"]
[]
[]
[]
[]
[]
[]
[]
["III.2.3-Abstract de un trabajo de investigación publicado o aceptado para su publicación:"]
["NOMBRE DE LA REVISTA",null,null,null,null,null,null,null,null,"VOLÚMEN",null,"NÚMERO",null,"AÑO"]
[]
[]
[]
[]
[]
["III.3 -DESARROLLOS TECNOLÓGICOS: "]
["Describir."]
[]
[]
[]
[]
["III.4 -OTRAS ACTIVIDADES RELACIONADAS CON INVESTIGACIÓN: "]
["Describir."]
[]
[]
[]
[]
[null,"IV – EXTENSIÓN UNIVERSITARIA"]
[]
[]
["IV.1-PROYECTOS DE EXTENSIÓN "]
["IV.1.1-PROYECTOS DE EXTENSIÓN EJECUTADOS:"]
["NOMBRE DEL PROYECTO",null,null,null,null,null,null,null,null,null,"RESOLUCIÓN Y FECHA DE APROBACIÓN DEL INFORME FINAL POR EL CONSEJO"]
[]
[]
[]
[]
[]
[]
[]
["IV.1.2-Proyectos de extensión aprobados academicamente , no ejecutados y sin financiación"]
["NOMBRE DEL PROYECTO",null,null,null,null,null,null,null,null,null,"FECHA DE APROBACIÓN ACADÉMICA"]
[]
[]
[]
[]
["IV.1.3-PROYECTOS DE EXTENSIÓN EN EJECUCIÓN:"]
["NOMBRE DEL PROYECTO",null,null,null,null,null,null,null,null,null,"CONSTANCIA DE APROBACIÓN ACADÉMICA POR ORGANISMO COMPETENTE"]
[]
[]
[]
[]
[]
["IV.2-OTRAS ACTIVIDADES RELACIONADAS CON EXTENSIÓN: "]
["IV.2.1-Arbitraje y evaluación de proyectos de extensión (Especificar y describir)"]
[]
[]
[]
["IV.2.2-Acciones articuladas con otras Instituciones (Especificar y describir)"]
[]
[]
[]
[null,"V - PUBLICACIONES"]
[]
[]
[]
["V.1-LIBROS o MANUALES:"]
["Especificar"]
[]
[]
[]
[]
["V.2-CAPITULOS DE LIBROS"]
["Especificar"]
[]
[]
[]
[]
["V.3-ARTÍCULOS ACADÉMICOS (revisiones bibliográficas, casos clínicos, procedimientos tecnológicos o terapéuticos, etc.)"]
["Especificar"]
[]
[]
[]
[]
["V.4-VIDEOS, CD`s o DVD`s:"]
["Especificar"]
[]
[]
[]
[]
["V.5-MONOGRAFÍAS (a disposición en la Biblioteca de F. de O.)"]
["TITULO",null,null,null,null,null,null,null,"AÑO",null,"OTROS DATOS QUE CONSIDERE PERTINENTES"]
[]
[]
[]
[]
[]
["V.6-ARTÍCULOS DE DIVULGACIÓN (prensa escrita, boletines, etc.)"]
["Especificar"]
[]
[]
[]
[]
["V.7-PUBLICACIONES SOBRE ENSEÑANZA:   "]
["TITULO",null,null,null,null,null,"AUTORES",null,null,null,null,"AÑO","NOMBRE DE LA REVISTA O LIBRO"]
[]
[]
[]
[]
["V.8-PUBLICACIONES SOBRE EXTENSIÓN:   "]
["TITULO",null,null,null,null,null,"AUTORES",null,null,null,null,"AÑO","NOMBRE DE LA REVISTA O LIBRO"]
[]
[]
[]
[]
[]
[]
[null,"VI – ACTIVIDAD ACADÉMICA"]
[]
[]
["VI.1-EXPOSITOR EN EVENTOS CIENTÍFICOS: "]
["VI.1.1-CURSOS CON CARGA HORARIA SUPERIOR A 4 HS.",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"FECHA"]
[]
[]
[]
[]
[]
[]
["VI.1.2-CONFERENCIAS (Especificar para que Organización)",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"FECHA"]
[]
[]
[]
[]
[]
["VI.1.3-TEMAS LIBRES, POSTERS, VIDEOS, CD`s, DVD`s, ETC.",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"FECHA"]
[]
[]
[]
[]
[]
[]
["VI.2-ORGANIZACIÓN DE EVENTOS ACADÉMICOS:"]
["EVENTO",null,null,null,null,null,null,null,"FUNCIÓN DESEMPEÑADA",null,null,null,null,null,null,"FECHA"]
[]
[]
[]
[]
[]
[]
["VI.3-ASISTENCIA A EVENTOS CIENTÍFICOS O ACADÉMICOS:"]
["EVENTO",null,null,null,null,null,"INSTITUCIÓN ORGANIZADORA",null,null,null,null,null,"TIPO",null,null,"FECHA"]
[]
[]
[]
[]
[]
[]
[]
["VI.4-PREMIOS Y/O DISTINCIONES: "]
["Especificar"]
[]
[]
[]
[]
["VI.5-INTEGRACIÓN DE TRIBUNALES: "]
["Especificar"]
[]
[]
[]
[]
[]
[]
["VI.6-INTEGRACIÓN DE COMISIONES ASESORAS PARA LA SELECCIÓN DE CARGOS DOCENTES (Especificar si son técnicas o co-gobernadas)"]
[]
[]
[]
[]
[]
[]
[]
[]
[]
["VI.7-ACTUACIÓN COMO PERITO:"]
["Especificar"]
[]
[]
[]
[]
[]
[]
["VI.8-INTEGRACIÓN DE SOCIEDADES CIENTÍFICAS:"]
["Especificar"]
[]
[]
[]
[]
[null,"VII – ACTIVIDADES DE APOYO AL CUMPLIMIENTO DE LOS FINES DE LA UNIVERSIDAD"]
[]
[]
["VII.1-DIRECCIÓN ACADÉMICO-ADMINISTRATIVA DE UNIDADES O SERVICIOS UNIVERSITARIOS: "]
["VII.1.1-Rector, Pro Rector, Decano"]
["CARGO DESEMPEÑADO",null,null,null,null,null,null,null,"DESDE",null,null,"HASTA"]
[]
[]
[]
[]
["VII.1.2-Directores de Escuela",null,null,null,null,null,null,null,"DESDE",null,null,"HASTA"]
[]
[]
[]
[]
["VII.1.3-DIRECTORES DE SERVICIOS, CARGOS DE COORDINACIÓN, DIRECCIÓN DE UNIDADES:"]
["CARGO DESEMPEÑADO",null,null,null,null,null,null,null,"DESDE",null,null,"HASTA"]
[]
[]
[]
[]
["VII.2-INTEGRACIÓN DE ÓRGANOS DE CO GOBIERNO:"]
["ÓRGANO INTEGRADO",null,null,null,null,null,null,null,null,null,null,"DESDE",null,null,"HASTA"]
["VII.2.1  Consejo Directivo Central, Consejo de Facultad, Comisión Directiva de Escuela"]
[]
[]
["VII.2.2 Claustro de Universidad, Claustro de Facultad"]
[]
[]
["VII.2.3 Directiva Asociaciones docente, profesionales y/o estudiantiles"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null," "]
[]
[]
[]
["VII.3-INTEGRACIÓN DE COMISIONES ASESORAS PERMANENTES DE LOS ÓRGANOS DE GOBIERNO :"]
["COMISIÓN INTEGRADA",null,null,null,null,null,null,null,"DESDE",null,null,"HASTA"]
[]
[]
[]
[]
["VII.4-INTEGRACIÓN DE COM. AD HOC, GRUPOS DE TRABAJO ASESORES DE LOS ÓRG. DE GOBIERNO:"]
["COMISIÓN O GRUPO DE TRABAJO INTEGRADO",null,null,null,null,null,null,null,"DESDE",null,null,"HASTA"]
[]
[]
[]
[]
["VII.5-DELEGACIÓN INSTITUCIONAL:"]
["DELEGADO/A",null,null,null,null,null,null,null,"DESDE",null,null,"HASTA"]
[]
[]
[]
[]
[]
[]
[]
[]
[null,"VIII – OTROS MÉRITOS Y ANTECEDENTES"]
[]
[]
["VIII.1 CALIFICACIÓN OBTENIDA EN LA MATERIA MOTIVO DEL LLAMADO"]
[]
["VIII.2 PROMEDIO GENERAL DE LA CARRERA"]
[]
["VIII.3    EJERCICIO PROFESIONAL ESPECIALIZADO:"]
["PROFESIÓN",null,null,null,null,null,"ESPECIALIDAD",null,null,null,null,"DESDE",null,"HASTA"]
[]
[]
[]
[]
["VIII.4 BECAS DE ESTUDIO",null,null,null,null,null,null,null,null,null,null,"DESDE",null,"HASTA"]
[]
[]
[]
[]
["VIII.5 BECA DE TRABAJO Y PASANTIA:",null,null,null,null,null,null,null,null,null,null,"DESDE",null,"HASTA"]
[]
[]
[]
[]
["VIII.6  OTROS:"]
["PROFESIÓN",null,null,null,null,null,null,null,null,null,null,"DESDE",null,"HASTA"]
[]
[]
[]
[]
["VIII.7  EJERCICIO PROFESIONAL GENERALISTA:"]
["PROFESIÓN",null,null,null,null,null,null,null,null,null,null,"DESDE",null,"HASTA"]
[]
[]
[]
[]
["VIII.8  CARGO PROFESIONAL EN SERVICIO DE SALUD DE LA ADMINISTRACIÓN PÚBLICA:"]
[null,null,null,null,null,null,null,null,null,null,null,"DESDE",null,"HASTA"]
[]
[]
[]
[]
["VIII.9 CONSIGNE OTROS MÉRITOS O ANTECEDENTES QUE ENTIENDA PERTINENTES."]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
["ME COMPROMETO A PRESENTAR LA DOCUMENTACIÓN ORIGINAL Y/O AUTENTICADA POR ESCRIBANO PÚBLICO, CORRESPONDIENTE A LA PRESENTE DECLARACIÓN JURADA, EN CASO QUE ME FUERA REQUERIDA POR LA COMISION ASESORA O EL TRIBUNAL DE CONCURSO INTERVINIENTE."]
[]
[]
[]
["DECLARO BAJO JURAMENTO LA AUTENTICIDAD DE LOS DATOS QUE FIGURAN EN EL PRESENTE CURRICULUM VITAE Y ASIMISMO CONOCER LAS  RESPONSABILIDADES QUE EMERGEN DE LA DECLARACIÓN JURADA” (art. Nº 239 del Código Penal)."]
[]
[]
[]
[]
[null,null,"FIRMA DEL ASPIRANTE",null,null,null,null,null,"FECHA"]
[]
[]
[]
[null,null,"ACLARACIÓN DE FIRMA"]