NG B, CHI B...........................

Chi b:.................................................

NG CNG SN VIT NAM

*
., ngy thng .. nm 2015

BN KIM IM C NHN
H v tn: .................................................... Ngy sinh......................................
Chc v ng :.....................................................................................................
Chc v chnh quyn, on th:...........................................................................
n v cng tc....................................................................................................
Chi b: ..................................................................................................................
I. u im, kt qu cng tc
1. V t tng, chnh tr :

2. V phm cht o c, li sng:..

...

..
..
3. V thc hin chc trch, nhim v c giao:
..

..
..
4. V thc t chc k lut:..

II. Khuyt im, hn ch v nguyn nhn:

.
.
.

.
.
III. Phng hng, bin php khc phc:.
..
.
..
IV. T nhn mc xp loi cht lng:..

NGI T KIM IM

(K, ghi r h v tn)

nh gi, phn loi cht lng ng vin:

- Nhn xt, nh gi ca chi y, chi b:
.................................................................................................................................
..
...
- Chi b phn loi cht lng:
..
.
- ng y, chi y c s phn loi cht lng:..
.
..
T.M CP Y
(K, ghi r h tn, thi im v ng du)