CNG HA X HI CH NGHA VIT NAM

c lp - T do- Hnh phc

S YU L LCH
nh 4x6

I. BN THN
1. H v tn (ch in hoa) ....Nam - N .
2. H v tn thng dng .....
3. Sinh ngy thng ..nm ......
4. Ni sinh
5. Nguyn qun .....
6. Ni ng k h khu thng tr ...
.........................................................................................................................................
7. Ch hin nay .....
.........................................................................................................................................
8. in thoi .....
9. Dn tc .Tn gio .....
10. Xut thn t gia nh ......
11. S chng minh..cp ngy ././..ni cp.
12. Trnh gio dc ph thng ..............
13. Trnh chuyn mn cao nht c o to .................
Ngnh hc ..Ni o to ....
14. Trnh l lun chnh tr ....
15. Ngy vo on TNCS H Ch Minh:
16. Ngy vo ng ..././.. Ngy chnh thc /../..
17. C quan cng tc hin nay .........
18. Chc v hin nay ...................
19. Hc v, Hc hm, danh hiu Nh nc phong tng . nm ....
20. Khen thng ..
21. K lut ...
II. QUAN H GIA NH
Ghi r h tn, nm sinh, ngh nghip, ni cng tc ca b m , anh ch em
rut, v (hoc chng), con
Quan h H v tn Nm sinh Ngh nghip Ni cng tc

TM TT QU TRNH O TO, CNG TC

Thi gian
Hnh thc o
t thng Tn trng Vn bng
Ngnh hc to (chnh quy
nm n hoc c s o to chng ch
hoc ti chc )
thng nm

Ti xin cam oan bn khai s yu l lch trn ng s tht, nu c iu g khng

ng ti chu trch nhim trc php lut v li khai ca mnh.

ngy thng nm

Xc nhn ca a phng Ngi khai

ni ng k h khu (k tn)