B GIO DC V O TO CNG HA X HI CH NGHA VIT NAM

TRNG I HC S PHM K THUT TP.HCM c lp T do Hnh Phc

H S NG K D THI I HC
(HNH THC VA LM VA HC)
Dn nh 3x4
c ng du
gip lai

A/ PHN BN THN
H v tn th sinh: (Vit ng nh giy khai sinh bng ch in hoa v c du)
..................................................................................................................... Gii (N ghi 1, Nam ghi 0):
Ngy, thng, nm sinh: (Ch ghi 2 s cui ca nm sinh)
ngy thng nm

Ni sinh (ch ghi tnh): .................................................................................................................................

H khu thng tr: ..................................................................................................................................
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Quc tch: .................... Dn tc: ................................................ Tn gio .................................................
Ngnh dng k d thi: .............. .................... Khi thi: M ngnh :

Thuc i tng u tin: 01, 02, 03, 04, 05, 06, 07. ( Khoanh tr vo k hiu ca i tng u tin, sau
k hiu vo bn cnh , nu khng thuc din u tin th trng)

Thuc khu vc u tin: KV1, KV2, KV2-NT, KV2, KV3. (Khoanh trn vo k hiu ca khu vc u tin)
Kt qu hc tp cui cp THPT, THBT, THN, THCN, CNKT, hoc CNKT; i vi khi lin thng th
ghi kt qu hc cao ng/cao ng ngh):
Xp loi v hc tp: ..............................................
Xp loi v hnh kim: .........................................
Xp loi tt nghip: ...............................................
Nm tt nghip:
THPT, THBT, THN, THCN, : ...............................
CNKT: ..................................................................
Cao ng: .............................................................
Giy chng minh nhn dn s: (Ghi mi s vo mt )

Ngy vo on TNCSHCM: ................................ ......................................................................................

Ngy vo ng CSVN: ......................................... ......................................................................................
Khi cn bo tin theo a ch: .................................. ......................................................................................
in thoi lin lc: ................................................ ......................................................................................
Khen thng: ......................................................... ......................................................................................
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K lut: ................................................................. ......................................................................................
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Tm tt qu trnh hc tp, cng tc v lao ng (ghi r thi gian, ni hc tp, cng tc, lao ng hoc n
v, phc v, chc v, danh hiu ngh nghip, bc lng) t nm 15 tui n nay.
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 B/ PHN GIA NH
1. Cha
H v tn: ......................................................................................... . Nm sinh: ........................................
Quc tch: .....................................................Dn tc ............................Tn gio: . ........................................
H khu thng tr:........................................................................... ................. ........................................
Ngh nghip hin nay: ....................................................................... ................. ........................................
Hot ng kinh t, chnh tr, x hi (lm g, u):
Trc 30/4/1975 ................................................................................ ................. ........................................
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Sau 30/4/19775 n nay: .................................................................... ................. ........................................
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2. M
H v tn: ......................................................................................... . Nm sinh: ........................................
Quc tch: .....................................................Dn tc ............................Tn gio: . ........................................
H khu thng tr:........................................................................... ................. ........................................
Ngh nghip hin nay: ....................................................................... ................. ........................................
Hot ng kinh t, chnh tr, x hi (lm g, u):
Trc 30/4/1975 ................................................................................ ................. ........................................
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Sau 30/4/19775 n nay: .................................................................... ................. ........................................
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3. V hoc chng:
H v tn: ......................................................................................... . Nm sinh: ........................................
Quc tch: .....................................................Dn tc ............................Tn gio: . ........................................
H khu thng tr:........................................................................... ................. ........................................
Ngh nghip hin nay: ....................................................................... ................. ........................................
Hot ng kinh t, chnh tr, x hi (lm g, u):
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4. Con: .................................................................................................. ................. ........................................
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5. H v tn, ngh nghip, ni ca anh ch em rut: ........................... ................. ........................................
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Ti xin cam oan nhng li khai trn l ng s tht. Nu c g sai ti xin chu trch nhim x l theo quy
ch tuyn sinh hin hnh ca B Gio dc v o to.
Ngy .......thng.......nm.......
Th sinh k tn

XC NHN NGI KHAI H S NY

ang cng tc ti: .............................................................................. ..........................................................
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Hoc ang thng tr ti phng, x: ............................................... ..........................................................
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Ty theo i tng th sinh, ngh n v chc nng (ti ni th sinh ang cng tc) hoc Cng an
phng, x (i vi th sinh ang c tr a phng) k tn v ng du.
Ngy.........thng.......nm .......
( Ghi r h tn, chc v ngi k v ng du)
 H S NG K D TUYN BAO GM

1. Phiu ng k d thi (theo mu bn trn)

2. 04 tm nh 3x4
3. Bn sao giy khai sinh.
4. Bn sao hc b cp 3
5. Giy Xc nhn thi gian cng tc (nu c)
6. Bn sao cc vn bng tt nghip v bng im:
a. i vi khi lin thng t trung cp ngh, trung hc chuyn nghip, cng nhn k
thut ...ln i hc:
Bn sao Bng tt nghip v bng im tt nghip Trung hc chuyn nghip chuyn
ngnh ng hoc gn vi ngnh o to.
Bn sao Bng tt nghip Trung hc ngh/bng ngh 3/7 chuyn ngnh ng vi ngnh
o to km bng tt nghip trung hc ph thng, bng im ngh.
b. i vi khi lin thng t cao ng chuyn nghip/cao ng ngh ln i hc
Bn sao Bng tt nghip Cao ng chuyn nghip/Cao ng ngh chuyn ngnh
ng vi ngnh o to.
Bn sao Bng im tt nghip Cao ng/Cao ng ngh.

LU TT C CC BN SAO U PHI C CNG CHNG