CONG

. HOA xA HOI. cnu NGHiA VIET

. NAM
Di)cl~p - TI}' do - H~nh phuc
Anh 3x4

SOYEULV qCH
Phan 1- Lich

su- ban than

1- He;>va ten:
2- Nam, nit
3- Ngay, thang, nam sinh:
,
4- ThuOng trU sf; nha:
dUOng:
PhuOng, xa:
.
Qu\U1(Huy~n):
6
..
- T-on glao:
5- D an te;>c:
7- Ngay tham gia t6 chuc (nong hQi, ph\! nft, cong doan):
..................................
t\li
8- Ngay vao Doan Thanh nien Ci)ng san Hi) Chi Minh:
t\li:
'D' ang C-e;>ngsan
'Y"tNIy am:
t\ll:.
9 - N.gay vao
10- Trinh di) van hoa:
Trinh di) dao t\lO chuyen mon nghi~p V\!:
nam t6t nghi~p:
11- Qua trinh hO\lt di)ng ban than (tom t~t til' 12 tu6i d~n nay, lam gi? 6 dau?)
.-, ,
"

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Phan II - Quan h~ gia mnh

12- He;>va ten cha:
Ngh~ nghi~p (chuc V\! va dp b(ic) truac va sau 30/4/1975:

Sinh nam:

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Ch8'6'h;~~.~~;;.:::::::::::::::::::::::::
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13- He;>,:a ten my:
;
Nghe nghi~p (chuc V\! va cap b(ic) truac va sau 30/4/1975:

Sinh nam:

.
.

Ch6 a hi~n nay:

14- HQ va ten vq (ho~c chang):
Ngh nghi~p (chuc V\l va d.p b;ic) truac va sau 3014/1975:

Sinh nam:

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Ch6 a hi~n nay:

15- HQ va ten cac con: Tu6i, lam gi,

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a diiu?

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16- HQ va ten anh, chj, em ruQt: Tu6i, lam gi,

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a diiu?

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Ngay

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thang
nam 2013
Ngrr01 khai
(kY ten)

NH~N XET vA CHUNG NH~N CVA UBND xA, PHlfONG NO! clf TRU
HO~C CO QUAN, TO CHUC NO! DANG CONG TAc
NQi dung chUng nh(in c~n ghi ban Ii Ijch nay dung hay sai. N6u sai thi ghi r6 sai
6 ch6 nao (co th~ nh(m xet v tu each ngh nghi~p va hoan canh)

- ,

Miiu so 1

CONG
. HoA xA HOI. CHU NGHiA VIET
. NAM
DQc I~p- TI! do - Hl.lDh phuc

DON DANG KY

nV

TUYEN

VI:EN CHUC

NgllDh giao d\lc va dao t~o qu~n Soon Tra nam hQc 2013-2014
Kinh gui:

HQi d6ng tuyn dVng vien chuc nganh

giao dvc va dao t~o qu~n San Tri

T6i ten la (chfr in hoa):

Nam, nil:

Ngay sinh:
Que quan:
HQ khAu thuOng tm:
Ch6

a hi~n nay:

Di~n tho~i lien I~c:

Dan tQc:
Trinh dQ va chuyen nganh dao t~o:
D6i tuqng uu tien (nSu co): (1)
Sau

khi

nghien

cUu

diu

ki~n

dang

kY dV tuyn

vien

chuc

cua

........................................

(2), t6i th:ly co du diu ki~n d tham dV kY thi

tuyn (ho(ic xet tuyn) vien chuc

a vi tri vi~c lam

(3). Vi

v~y, t6i lam dan nay dang ky dv tuyn vien chuc theo th6ng bao cui quy ca
quan, dan vi.
NSu tmng tuyn t6i se ch:lp hanh cac quy dinh cua Nha nuac va cua ca quan, dan
vi co thAm quyn tuyn dVng.
T6i gui kern thea dan nay h6
1. Ban

So'

So'

dv tuyn, g6m:

ySu ly lich tv thu~t;

2. Bim chvp cac van b~ng, chUng chi va kSt qua hqc t~p, g6m:
3. Gi:ly chung nh~n suc khoe;
4.02 phong bi (ghi ra dja chi lien l~c), 02 anh co 4 x 6.

(4)

T6i cam doan h6 sa d\l' tuySn ella t6i Ia dung S\l' th~t. N~u sai S\l' th~t, k~t qua
tuySn d\lIlg ella t6i hllY b6 va t6i chiu tnich nhi~m tm6'c phap lu~t.I.

Kinh dan
(Ky va ghi r5 h9 ten)
Ghi ehti:
(1) Ghi r5 d6i tUQ'IlgUti tien theo quy dinh;
(2) Ghi dung ten dan vi S\l'nghi~p co thOng bao tuySn d\lng vi en chlrc;
(3) Ghi dUng vi tri vi~c lam dn tuySn ella dan vi S\l'nghi~p tuySn d\lng;
(4) Ghi r5 ten ella cae ban ch\lp, dugc co quan co thftm quySn chUng th\l'c, gui
kern dan dang kY d\l' tuySn.