B Y T TRNG I HC Y DC CN TH

CNG HA X HI CH NGHA VIT NAM

c lp T do Hnh phc

L LCH KHOA HC
I. L LCH S LC H v tn: Ngy, thng, nm sinh: Qu qun: Hc v cao nht: Chc danh khoa hc cao nht: Chc danh ngh nghip (GV/GVC): Chc v (hin ti hoc trc khi ngh hu): n v cng tc (hin ti hoc trc khi ngh hu): Ch ring hoc a ch lin lc: in thoi lin h: CQ: Fax: II. QU TRNH O TO 1. i hc: H o to: Ni o to: Ngnh hc: Nc o to: Bng i hc 2: 2. Sau i hc Thc s chuyn ngnh (hoc BS.CKI): Tin s chuyn ngnh (hoc BS.CKII): Nm cp bng: Nm cp bng: Ni o to: M s chuyn ngnh c o to: Ni o to: Tn lun n: Nm tt nghip: Nm tt nghip: NR: Email: D: Gii tnh: Ni sinh: Dn tc: Nm nhn hc v: Nc nhn hc v: Nm b nhim: Nm b nhim:

L lch khoa hc dnh cho ging vin

3. Chng ch b tc Sau i hc: 4. Ngoi ng: 1. 2. Mc s dng: Mc s dng:

III. QU TRNH CNG TC CHUYN MN Thi gian Ni cng tc Cng vic m nhim

IV. QU TRNH NGHIN CU KHOA HC 1. Cc ti nghin cu khoa hc va ang tham gia: TT Tn ti nghin cu Nm bt u/Nm hon thnh ti cp (NN, B, ngnh, trng) Trch nhim tham gia trong ti

2. Cc cng trnh khoa hc cng b: (tn cng trnh, nm cng b, ni cng b...) TT Tn cng trinh Nm cng b Tn tap chi

3. Cc ti hng dn hc vin, sinh vin thc hin: (tn ti, tn hc vin, kha hc, ni hc...) TT Tn ti Tn hc vin Kha hc/ bc hc Ni o to

., ngy
Xc nhn ca c quan

thng

nm

Ngi khai k tn (Ghi r chc danh, hc v)

L lch khoa hc dnh cho ging vin