CNG HO X HI CH NGHA VIT NAM

c lp - T do - Hnh phc
Hnh 3x4

L LCH HUN LUYN VIN

MN TH THAO:...................................................

1. H v Tn:.................................................................................Nam N
2. Ngy thng nm sinh:...............................................Ni sinh:..................................
3. Dn tc:............................................................................ Tn gio:.................................
4. Qu qun:............................................................................................................
5. S CMND:.....................................Cp ngy:............................Ni cp:..........................
6. a ch thng tr:.............................................................................................................
7. S in thoi lin lc:....................................Email:..........................................................
8. Xut thn trc khi tr thnh HLV:..................................................................................
(Ghi r loi ng cp nu l VV:...............................................................................)
9. n v cng tc (ngoi CT hun luyn cc tuyn):...........................................................
10. Trnh chnh tr: ng vin on vin ; Ngy kt np:........................
11. Trnh :

Vn ha: .....................................................................................................................
(ghi r cp bc, trng lp hoc ang theo hc.)

Chuyn mn:..............................................................................................................

12. Trnh ngoi ng::........................................................................................................

Bng cp (chng ch):................................................................................................
Kh nng: nghe ni c vit

13. Trnh hun luyn:......................................Ngch HLV..............................................

Hun luyn tuyn:...........................Nm bt u hun luyn:...................................
Hun luyn i: TQG Tr QG
(Thi gian:............................................................................................)

14. Hon cnh gia nh:........................................................................................................

c thn C gia nh S con:..............................
15. C kh nng, iu kin tp hun di hn ngoi Thnh ph H Ch Minh:

i tr QG
i DTQG
Tp hun nc ngoi di hn

1
16. Qu trnh cng tc:
Nm:Cng vic:.Ti:..
Nm:Cng vic:.Ti:..
Nm:Cng vic:.Ti:..
Nm:Cng vic:.Ti:..

17. Tham d cc kha o to, bi dng:

Nm..Kha:Kt qu:..
Nm..Kha:Kt qu:..
Nm..Kha:Kt qu:..
Nm..Kha:Kt qu:..

18. Khen thng:

Cp Nh nc:....................................................................................Nm...............
Cp U ban TDTT:.............................................................................Nm...............
Cp Thnh ph:..................................................................................Nm................

Thnh ph H Ch Minh, ngy thng nm

Xc nhn ca n v (Chnh quyn) Hun luyn vin (K, ghi r h tn)