NG B TNH NG NAI

NG Y KHI DN CHNH NG
NG Y TRNG H LC HNG
Chi b: .

NG CNG SN VIT NAM

PHIU B SUNG
H S NG VIN NM 201_

MU 3 HSV
S LL: . . . . . . . . .
S TV: . . . . . . . . ..

H V TN:...., sinh ngy: ...........................................

Ngy vo ng: d b ../../, chnh thc /./, in thoi lin lc ................................
Ch hin nay (O thng tr, O tm tr - ghi chi tit): ...........................................................................
....................................................................................................................................................................
Ngh nghip, n v cng tc: ...................................................................................................................
Chc v c giao: ng: ........................................................................................................................
Chnh quyn: on th: ...................................................................
Trnh hc vn, chuyn mn nghip v: ................................................................................................
- Gio dc ph thng (lp my): ..............., Chuyn mn nghip v: ....................................................
- Hc v (TS, Thc s): .., Hc hm (GS, PGS): ........................................................
- L lun chnh tr (c nhn, cao cp, trung cp, s cp): ....................................................................
- Ngoi ng: ............................................................................................................................................
Hnh thc khen thng nhn trong nm (t bng khen, huy chng tr ln, danh hiu mi c
phong Anh hng, CST, Nh gio u t, NGND): ...................................................................................
....................................................................................................................................................................
B x l k lut: ........................................................................................................................................
Gia nh thay i:
- Cha : .., M : ............................................................................
- Cha (v/chng): .., M (v/chng): ............................................................
- V/chng (h tn, kt hn, ly hn, t trn, chc v, cng vic): ...........................................................
....................................................................................................................................................................
Con (h tn, lm g, u): ......................................................................................................................
....................................................................................................................................................................
Kinh t ca bn thn v gia nh:
- Tng mc thu nhp ca h gia nh: .. ng, bnh qun ngi/h: .. ng.
- Nh : ....................................................................................................................................................
- t : .....................................................................................................................................................
- Hot ng kinh t: .................................................................................................................................
- Ti sn c gi tr (50 triu ng tr ln) Tn ti sn: ............................................................................
....................................................................................................................................................................
Kt qu nh gi cht lng ng vin trong nm 201_: ........................................................................
Bin Ha, ngy . thng . nm ..
XC NHN CA NG Y
XC NHN CA CHI B
NGI KHAI
B TH
B TH