เอกสาร ๒ ใบสมัคร

ใบสมัครครูดีไม่มีอบายมุข พ.ศ. ๒๕๖๕ ปีที่๑๒ (รุ่นติดตามความเพียร )

“คนไม่มีความสุจริต คนไม่มีความมัน่ คง ชอบแต่มกั ง่าย ไม่มวี นั จะสร้างสรรค์ประโยชน์ส่วนรวมทีส่ าคัญอัน

ใดได้ ผูท้ ม่ี คี วามสุจริตและความมุง่ มันเท่
่ านัน้ จึงจะทางานสาคัญยิง่ ใหญ่ทเ่ี ป็ นคุณประโยชน์แท้จริงได้สาเร็จ ”

พระบรมราโชวาทของพระบาทสมเด็จพระเจ้าอยู่หวั ในพิธีพระราชทานปริญญาบัตรของจุฬาลงกรณ์มหาวิทยาลัย ๑๒ กรกฎาคม ๒๕๒๒

โปรดกรอกข้อมูล ด้วยลายมือตนเอง ตัวบรรจง ให้ครบทุกข้อด้วยความซื่อสัตย์สุจริต

 ให้ท่านอ่านพระบรมราโชวาททีอ่ ญั เชิญมานี้ แล ้วสะท้อนความรูส้ กึ ทีไ่ ด้อ่าน และแสดงความคิดเห็นของตนเองว่า

หากตัวเราเองและคนไทยทัว่ ไป ขาดการปฏิบตั ติ นตามพระบรมราโชวาทนี้ จะเกิดผลอย่างไรต่อประเทศไทย
และท่านจะมีส่วนร่วมอย่างไรในการป้ องกัน แก้ไขมิให้เกิดปัญหานี้
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โปรดศึกษาเอกสารให้ครบทัง้ ๓ชุดในการสมัคร / เอกสาร๑คาชีแ้ จง / เอกสาร๒ ใบสมัคร / เอกสาร๓ อบายมุข ๖
 เอกสาร ๒ ใบสมัคร

ภาพถ่าย
ขนาด๑นิว้
โปรดกรอกข้อมูล ด้วยลายมือตนเอง ตัวบรรจง ให้ครบทุกข้อด้วยความซื่อสัตย์สุจริต ติดด้วยลวดเย็บ

ส่วนที่ ๑ ข้อมูลส่วนตัว
ข้าพเจ้า (ชื่อ – นามสกุล).................................................................................................ตาแหน่งปัจจุบัน..............................
วัน/เดือน/ปี เกิด .........................................อายุ...........ปี เชื้อชาติ...................สัญชาติ........................ศาสนา.....................
สถานภาพ โสด สมรส อื่น ๆ (ระบุ)................................................... มีบุตรจานวน ...................... คน

ที่อยู่ตามบัตรประชาชน เลขที่.........หมู่........ตาบล..............................................อาเภอ.............................................................
จังหวัด............................................................................หมายเลขโทรศัพท์มือถือ......................................................................
ชื่อเฟสบุ๊คที่ใช้ในปัจจุบัน.....................................................................................................ID line...........................................
ชื่อสถานที่ทางาน.................................................................................................สังกัด.............................................................
เลขที.่ ...............................ตาบล................................อาเภอ......................................จังหวัด.....................................................
รหัสไปรษณีย.์ ............ โทรศัพท์.............................................. โทรสาร....................................................................................
เปิดสอนตั้งแต่ระดับชัน้ .......................ถึง........................ จานวนครู.....................คน จานวนนักเรียน...........................คน
หน้าทีร่ ับผิดชอบในสถานที่ทางาน..............................................................................................................................................
ชื่อ-นามสกุลผู้บริหาร.................................................................................หมายเลขโทรศัพท์มือถือ..........................................

ประวัตกิ ารศึกษาของข้าพเจ้า
การศึกษาสูงสุด (ระบุ)..............................................................................................................................................................
คณะ…………………….……………………………..…........................................................วิชาเอก..........................................................
ชื่อสถาบัน....................................................................................................................................................................................
ประสบการณ์ในการเป็นครู (นับตั้งแต่เริ่มทางานมิใช่เริ่มได้บรรจุ)........ปี.................................................................................
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ข้าพเจ้ามีความประสงค์สมัครเข้ารับการคัดเลือกเพื่อรับรางวัลครูดีไม่มีอบายมุข รุ่นที่๑๒
(โปรดให้ข้อมูลของท่าน ด้วยการทาเครื่องหมาย / ในช่อง และระบุรายละเอียดให้ครบถ้วนทุกข้อ )
 สถานภาพปัจจุบัน
 ครู  ผู้บริหารสถานศึกษา  ผู้บริหารเขตพื้นที่การศึกษา
 ศึกษานิเทศก์ นักวิชาการ  อื่น ๆ โปรดระบุ …………………………..………..............
 สังกัด
 สพป. …………………………………………………..……………………….….…. เขต …………..………………......................………….
 สพม. ………………………………………………………………… จังหวัด ………………………………….....................….……………..
 สังกัดอื่น ๆ โปรดระบุ……………………………………………………………….จังหวัด ……………….....................…………………

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โปรดศึกษาเอกสารให้ครบทัง้ ๓ชุดในการสมัคร / เอกสาร๑คาชีแ้ จง / เอกสาร๒ ใบสมัคร / เอกสาร๓ อบายมุข ๖
 เอกสาร ๒ ใบสมัคร

โปรดกรอกข้อมูล ด้วยลายมือตนเอง ตัวบรรจง ให้ครบทุกข้อด้วยความซื่อสัตย์สุจริต

ส่วนที่ ๒ ข้อมูลยืนยันคุณสมบัติตนเอง เพื่อเข้ารับการคัดเลือกในโครงการครูดีไม่มีอบายมุข
ปีการศึกษา ๒๕๖๕ ปีที่๑๒ (โปรดทาเครื่องหมาย / ในช่อง ตามความเป็นจริงให้ครบ
ถ้วนทุกข้อ)
 เป็นผูม้ ีความซื่อสัตย์สุจริตเป็นปกติ โปรดยกตัวอย่างที่ท่านปฏิบัติ......................................................................
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 เป็นผู้เคยได้รับโล่ประกาศเกียรติคุณครูดฯี รุ่นที…่ …………...........พ.ศ. …………………….........................................
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 เป็นผู้เคยได้รับเกียรติบัตรครูดีไม่มีอบายมุข รุ่นที่..................................................................................................
พ.ศ............................................................................................................................................................................
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(หากได้รับเกียรติบัตรหลายปี โปรดระบุทั้งหมด ที่มีชื่อตนเองพร้อมแนบภาพประกอบทั้งโล่ฯและเกียรติบัตร)
 เป็นผู้ประพฤติปฏิบัติตนตามหลักศาสนาทีต่ นนับถือในชีวิตประจาวัน (ชาวพุทธคือศีล๕)
 เป็นผู้ที่ยังครองตนพ้นอบายมุข6 (โปรดศึกษาเอกสารหมายเลข ๓ ในการขยายความอบายมุข๖
เพื่อประกอบในการประเมินคุณสมบัติตนเอง ให้เขียนรายละเอียดในแต่ละข้อ๖ข้อตามที่ท่านปฏิบัติจริง )
1. ดื่มเหล้า, เบียร์, เครื่องดื่มที่มีแอลกอฮอล์/สูบบุหรี่.............................................................................................................
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2. เที่ยวสถานบันเทิงเป็นประจา..............................................................................................................................................
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3. เสพติดการดูการละเล่น/การแสดง เฟสบุ๊ค สื่อออนไลน์ต่างๆ...........................................................................................
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4. เล่นการพนันทุกรูปแบบ สลากกินแบ่งรัฐบาล หวยใต้ดินหรือเกมการพนันต่างๆ.................................................................
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5. เกียจคร้านการทางานใช้เวลาทางานไปหารายได้พิเศษ ไม่ทางานตามหน้าที่รับผิดชอบ.......................................................
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6. คบหาสมาคมคนชั่วเป็นมิตร..................................................................................................................................................
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อื่นๆ ...............………………………………………………………………………..................................………………….................................…..
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3
โปรดศึกษาเอกสารให้ครบทัง้ ๓ชุดในการสมัคร / เอกสาร๑คาชีแ้ จง / เอกสาร๒ ใบสมัคร / เอกสาร๓ อบายมุข ๖
 เอกสาร ๒ ใบสมัคร

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โปรดกรอกข้อมูล ด้วยลายมือตนเอง ตัวบรรจง ให้ครบทุกข้อด้วยความซื่อสัตย์สุจริต
ส่วนที่ ๓ ข้อมูลกิจกรรมที่ท่านทา เพื่อให้เกิดการลด เลิก อบายมุข (เน้นเหล้า เบียร์ บุหรี่ การพนัน
ทุกรูปแบบ) หลังจากที่ได้รับโล่ฯและเกียรติบัตรครูดีไม่มีอบายมุข ทาต่อเนื่องเป็นเวลา ๒ปี
(อาจมีมากกว่า๑ผลงานได้) หากเป็นการขับเคลื่อนงานเดิมแต่เป็น ความต่อเนื่อง หรือการต่อยอดขยาย
ผล ขอให้ระบุรายละเอียดในแต่ละปี ทั้ง๒ ปี ให้ชัดเจน ตามที่กาหนดทั้งหมดใน ข้อชื่อผลงาน

ชื่อผลงาน...............................................................................................................................................
- กลุ่มเป้าหมายคือ.....................................................................................................จานวน............คน
- ระยะเวลา...........................................................................................................................................
- สภาพปัญหาก่อนการดาเนินการในกลุ่มเป้าหมาย ที่ยุ่งเกี่ยวกับอบายมุข หรือเป็นผู้ได้รับผลกระทบ
จากอบายมุข (เน้นเหล้า เบียร์ บุหรี่ การพนัน)
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- สาเหตุของปัญหาอบายมุขที่เกิดกับกลุ่มเป้าหมายที่ท่านดาเนินการ..............................................................................
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โปรดศึกษาเอกสารให้ครบทัง้ ๓ชุดในการสมัคร / เอกสาร๑คาชีแ้ จง / เอกสาร๒ ใบสมัคร / เอกสาร๓ อบายมุข ๖
 เอกสาร ๒ ใบสมัคร

....................................................................................................................................................................................................
โปรดกรอกข้อมูล ด้วยลายมือตนเอง ตัวบรรจง ให้ครบทุกข้อด้วยความซื่อสัตย์สุจริต
- กิจกรรมที่ทา (ได้ลงมือทาไปแล้ว) และลงถึงตัวกลุ่มเป้าหมายให้เกิดผล ลด เลิก อบายมุข (เน้นเหล้า เบียร์
บุหรี่ การพนัน) ไม่เกิน ๔ หน้า A4 ไม่รวมภาพประกอบ ระบุรายละเอียดกิจกรรมให้ชัดเจน

รายละเอียดกิจกรรม
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โปรดศึกษาเอกสารให้ครบทัง้ ๓ชุดในการสมัคร / เอกสาร๑คาชีแ้ จง / เอกสาร๒ ใบสมัคร / เอกสาร๓ อบายมุข ๖
 เอกสาร ๒ ใบสมัคร

โปรดกรอกข้อมูล ด้วยลายมือตนเอง ตัวบรรจง ให้ครบทุกข้อด้วยความซื่อสัตย์สุจริต

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โปรดศึกษาเอกสารให้ครบทัง้ ๓ชุดในการสมัคร / เอกสาร๑คาชีแ้ จง / เอกสาร๒ ใบสมัคร / เอกสาร๓ อบายมุข ๖
 เอกสาร ๒ ใบสมัคร

โปรดกรอกข้อมูล ด้วยลายมือตนเอง ตัวบรรจง ให้ครบทุกข้อด้วยความซื่อสัตย์สุจริต

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โปรดศึกษาเอกสารให้ครบทัง้ ๓ชุดในการสมัคร / เอกสาร๑คาชีแ้ จง / เอกสาร๒ ใบสมัคร / เอกสาร๓ อบายมุข ๖
 เอกสาร ๒ ใบสมัคร

โปรดกรอกข้อมูล ด้วยลายมือตนเอง ตัวบรรจง ให้ครบทุกข้อด้วยความซื่อสัตย์สุจริต

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โปรดศึกษาเอกสารให้ครบทัง้ ๓ชุดในการสมัคร / เอกสาร๑คาชีแ้ จง / เอกสาร๒ ใบสมัคร / เอกสาร๓ อบายมุข ๖
 เอกสาร ๒ ใบสมัคร

โปรดกรอกข้อมูล ด้วยลายมือตนเอง ตัวบรรจง ให้ครบทุกข้อด้วยความซื่อสัตย์สุจริต

- ผลที่ปรากฏกับกลุ่มเป้าหมาย หลังทากิจกรรม (ไม่เน้นเรื่องการได้รับรางวัล )

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9
โปรดศึกษาเอกสารให้ครบทัง้ ๓ชุดในการสมัคร / เอกสาร๑คาชีแ้ จง / เอกสาร๒ ใบสมัคร / เอกสาร๓ อบายมุข ๖
 เอกสาร ๒ ใบสมัคร

- โปรดกรอกข้อมูล ด้วยลายมือตนเอง ตัวบรรจง ให้ครบทุกข้อด้วยความซื่อสัตย์สุจริต

- กิจกรรมที่ท่านทา กิจกรรมใดที่ส่งผลมากต่อการ ลด เลิก อบายมุข (เน้นเหล้า เบียร์ บุหรี่ การพนัน)

ในกลุ่มเป้าหมาย โปรดอธิบาย
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10
โปรดศึกษาเอกสารให้ครบทัง้ ๓ชุดในการสมัคร / เอกสาร๑คาชีแ้ จง / เอกสาร๒ ใบสมัคร / เอกสาร๓ อบายมุข ๖
 เอกสาร ๒ ใบสมัคร

โปรดกรอกข้อมูล ด้วยลายมือตนเอง ตัวบรรจง ให้ครบทุกข้อด้วยความซื่อสัตย์สุจริต

- ระบุกรณีศึกษา ที่มีพัฒนาการ หรือประสบผลสาเร็จ ในการ ลด เลิก อบายมุข (เน้นเหล้า เบียร์
บุหรี่ การพนัน) ที่สร้างพลังให้ท่าน และนาไปสู่การเปลี่ยนแปลงคุณภาพชีวติ คุณภาพชุมชน หรืออื่นๆ สามารถระบุชื่อ
หน่วยงานหรือบุคคล ประกอบได้
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11
โปรดศึกษาเอกสารให้ครบทัง้ ๓ชุดในการสมัคร / เอกสาร๑คาชีแ้ จง / เอกสาร๒ ใบสมัคร / เอกสาร๓ อบายมุข ๖
 เอกสาร ๒ ใบสมัคร

...................................................................... ..............................................................................................................................
โปรดกรอกข้อมูล ด้วยลายมือตนเอง ตัวบรรจง ให้ครบทุกข้อด้วยความซื่อสัตย์สุจริต

- ระบุบทบาทหน้าที่ของท่าน ต่อการทากิจกรรมนี้
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12
โปรดศึกษาเอกสารให้ครบทัง้ ๓ชุดในการสมัคร / เอกสาร๑คาชีแ้ จง / เอกสาร๒ ใบสมัคร / เอกสาร๓ อบายมุข ๖
 เอกสาร ๒ ใบสมัคร

โปรดกรอกข้อมูล ด้วยลายมือตนเอง ตัวบรรจง ให้ครบทุกข้อด้วยความซื่อสัตย์สุจริต

ภาพประกอบผลงาน ๒ภาพ ระบุรายละเอียดภาพโดยสังเขป

13
โปรดศึกษาเอกสารให้ครบทัง้ ๓ชุดในการสมัคร / เอกสาร๑คาชีแ้ จง / เอกสาร๒ ใบสมัคร / เอกสาร๓ อบายมุข ๖
 เอกสาร ๒ ใบสมัคร

โปรดกรอกข้อมูล ด้วยลายมือตนเอง ตัวบรรจง ให้ครบทุกข้อด้วยความซื่อสัตย์สุจริต

ภาพประกอบ ๒ภาพ ระบุรายละเอียดภาพโดยสังเขป

14
โปรดศึกษาเอกสารให้ครบทัง้ ๓ชุดในการสมัคร / เอกสาร๑คาชีแ้ จง / เอกสาร๒ ใบสมัคร / เอกสาร๓ อบายมุข ๖
 เอกสาร ๒ ใบสมัคร

โปรดกรอกข้อมูล ด้วยลายมือตนเอง ตัวบรรจง ให้ครบทุกข้อด้วยความซื่อสัตย์สุจริต

ชื่อผลงาน(กรณีมีมากกว่า๑ผลงาน)...............................................................................................................................
- กลุ่มเป้าหมายคือ.....................................................................................................จานวน............คน
- ระยะเวลา...........................................................................................................................................
- สภาพปัญหาก่อนการดาเนินการในกลุ่มเป้าหมาย ที่ยุ่งเกี่ยวกับอบายมุข หรือเป็นผู้ได้รับผลกระทบ
จากอบายมุข (เน้นเหล้า เบียร์ บุหรี่ การพนัน)
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- สาเหตุของปัญหาอบายมุขที่เกิดกับกลุ่มเป้าหมายที่ท่านดาเนินการ..............................................................................
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15
โปรดศึกษาเอกสารให้ครบทัง้ ๓ชุดในการสมัคร / เอกสาร๑คาชีแ้ จง / เอกสาร๒ ใบสมัคร / เอกสาร๓ อบายมุข ๖
 เอกสาร ๒ ใบสมัคร

โปรดกรอกข้อมูล ด้วยลายมือตนเอง ตัวบรรจง ให้ครบทุกข้อด้วยความซื่อสัตย์สุจริต

- กิจกรรมที่ทา (ได้ลงมือทาไปแล้ว) และลงถึงตัวกลุ่มเป้าหมายให้เกิดผล ลด เลิก อบายมุข (เน้นเหล้า เบียร์
บุหรี่ การพนัน) ไม่เกิน ๔ หน้า A4 ไม่รวมภาพประกอบ ระบุรายละเอียดกิจกรรมให้ชัดเจน

รายละเอียดกิจกรรม
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16
โปรดศึกษาเอกสารให้ครบทัง้ ๓ชุดในการสมัคร / เอกสาร๑คาชีแ้ จง / เอกสาร๒ ใบสมัคร / เอกสาร๓ อบายมุข ๖
 เอกสาร ๒ ใบสมัคร

โปรดกรอกข้อมูล ด้วยลายมือตนเอง ตัวบรรจง ให้ครบทุกข้อด้วยความซื่อสัตย์สุจริต

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17
โปรดศึกษาเอกสารให้ครบทัง้ ๓ชุดในการสมัคร / เอกสาร๑คาชีแ้ จง / เอกสาร๒ ใบสมัคร / เอกสาร๓ อบายมุข ๖
 เอกสาร ๒ ใบสมัคร

โปรดกรอกข้อมูล ด้วยลายมือตนเอง ตัวบรรจง ให้ครบทุกข้อด้วยความซื่อสัตย์สุจริต

..................... ..........................................................................................................................................................................
. โปรดกรอกข้อมูล ด้วยลายมือตนเอง ตัวบรรจง ให้ครบทุกข้อด้วยความซื่อสัตย์สุจริต

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18
โปรดศึกษาเอกสารให้ครบทัง้ ๓ชุดในการสมัคร / เอกสาร๑คาชีแ้ จง / เอกสาร๒ ใบสมัคร / เอกสาร๓ อบายมุข ๖
 เอกสาร ๒ ใบสมัคร

โปรดกรอกข้อมูล ด้วยลายมือตนเอง ตัวบรรจง ให้ครบทุกข้อด้วยความซื่อสัตย์สุจริต

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19
โปรดศึกษาเอกสารให้ครบทัง้ ๓ชุดในการสมัคร / เอกสาร๑คาชีแ้ จง / เอกสาร๒ ใบสมัคร / เอกสาร๓ อบายมุข ๖
 เอกสาร ๒ ใบสมัคร

โปรดกรอกข้อมูล ด้วยลายมือตนเอง ตัวบรรจง ให้ครบทุกข้อด้วยความซื่อสัตย์สุจริต

-
- ผลที่ปรากฏกับกลุ่มเป้าหมาย หลังทากิจกรรม (ไม่เน้นเรื่องการได้รับรางวัล )
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20
โปรดศึกษาเอกสารให้ครบทัง้ ๓ชุดในการสมัคร / เอกสาร๑คาชีแ้ จง / เอกสาร๒ ใบสมัคร / เอกสาร๓ อบายมุข ๖
 เอกสาร ๒ ใบสมัคร

- โปรดกรอกข้อมูล ด้วยลายมือตนเอง ตัวบรรจง ให้ครบทุกข้อด้วยความซื่อสัตย์สุจริต

-
- .กิจกรรมที่ท่านทา กิจกรรมใดที่ส่งผลมากต่อการ ลด เลิก อบายมุข (เน้นเหล้า เบียร์ บุหรี่ การพนัน)
ในกลุ่มเป้าหมาย โปรดอธิบาย
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21
โปรดศึกษาเอกสารให้ครบทัง้ ๓ชุดในการสมัคร / เอกสาร๑คาชีแ้ จง / เอกสาร๒ ใบสมัคร / เอกสาร๓ อบายมุข ๖
 เอกสาร ๒ ใบสมัคร

โปรดกรอกข้อมูล ด้วยลายมือตนเอง ตัวบรรจง ให้ครบทุกข้อด้วยความซื่อสัตย์สุจริต

- ระบุกรณีศึกษา ที่มีพัฒนาการ หรือประสบผลสาเร็จ ในการ ลด เลิก อบายมุข (เน้นเหล้า เบียร์

บุหรี่ การพนัน) ที่สร้างพลังให้ท่าน และนาไปสู่การเปลี่ยนแปลงคุณภาพชีวติ คุณภาพชุมชน หรืออื่นๆ สามารถระบุชื่อ
หน่วยงานหรือบุคคล ประกอบได้

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22
โปรดศึกษาเอกสารให้ครบทัง้ ๓ชุดในการสมัคร / เอกสาร๑คาชีแ้ จง / เอกสาร๒ ใบสมัคร / เอกสาร๓ อบายมุข ๖
 เอกสาร ๒ ใบสมัคร

โปรดกรอกข้อมูล ด้วยลายมือตนเอง ตัวบรรจง ให้ครบทุกข้อด้วยความซื่อสัตย์สุจริต

- ระบุบทบาทหน้าที่ของท่าน ต่อการทากิจกรรมนี้
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โปรดศึกษาเอกสารให้ครบทัง้ ๓ชุดในการสมัคร / เอกสาร๑คาชีแ้ จง / เอกสาร๒ ใบสมัคร / เอกสาร๓ อบายมุข ๖
 เอกสาร ๒ ใบสมัคร

โปรดกรอกข้อมูล ด้วยลายมือตนเอง ตัวบรรจง ให้ครบทุกข้อด้วยความซื่อสัตย์สุจริต

ภาพประกอบผลงาน ๒ภาพ ระบุรายละเอียดภาพโดยสังเขป

24
โปรดศึกษาเอกสารให้ครบทัง้ ๓ชุดในการสมัคร / เอกสาร๑คาชีแ้ จง / เอกสาร๒ ใบสมัคร / เอกสาร๓ อบายมุข ๖
 เอกสาร ๒ ใบสมัคร

โปรดกรอกข้อมูล ด้วยลายมือตนเอง ตัวบรรจง ให้ครบทุกข้อด้วยความซื่อสัตย์สุจริต

ภาพประกอบผลงาน ๒ภาพ ระบุรายละเอียดภาพโดยสังเขป

25
โปรดศึกษาเอกสารให้ครบทัง้ ๓ชุดในการสมัคร / เอกสาร๑คาชีแ้ จง / เอกสาร๒ ใบสมัคร / เอกสาร๓ อบายมุข ๖
 เอกสาร ๒ ใบสมัคร

โปรดกรอกข้อมูล ด้วยลายมือตนเอง ตัวบรรจง ให้ครบทุกข้อด้วยความซื่อสัตย์สุจริต

๔.ข้อมูลอื่นๆ ทีต่ ้องการเพิ่มเติม (ถ้ามี)

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๕.การรับรองตนเอง
ข้าพเจ้าขอรับรองว่า ข้อมูลทั้งหมดข้างต้น เป็นข้อมูลที่มาจากความซื่อสัตย์สุจริต โดยมิได้คัดลอกตัดต่อ
จากผู้ใด หากคณะกรรมการ ตรวจสอบแล้วพบว่า การปฏิบัติตัวของข้าพเจ้ามีอบายมุข ข้อมูลส่วนใดส่วนหนึ่ง
ในใบสมัครเป็นความเท็จขาดความซื่อสัตย์ ข้าพเจ้ายินดีให้ตัดสิทธิ์จากการคัดเลือก และถึงแม้ได้รับคัดเลือกเป็น
ครูดีไม่มีอบายมุขก็ยินยอมให้ยกเลิกรางวัล
ข้าพเจ้า ขอตั้งสัจอธิษฐานว่า........................................................................................................................
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ลงชื่อ………………………………………………………………..
(…………………………………………………………………………)
ตาแหน่ง…………………………………………………………………………………………….
ชื่อสถานที่ทางาน........................................................................................................
สังกัด…………………………………………………………………………………................................
26
โปรดศึกษาเอกสารให้ครบทัง้ ๓ชุดในการสมัคร / เอกสาร๑คาชีแ้ จง / เอกสาร๒ ใบสมัคร / เอกสาร๓ อบายมุข ๖
 เอกสาร ๒ ใบสมัคร

โปรดกรอกข้อมูล ด้วยลายมือตนเอง ตัวบรรจง ให้ครบทุกข้อด้วยความซื่อสัตย์สุจริต

๖.ผูร้ ับรอง
ผู้รับรองโปรดอ่าน
ขอให้ท่านให้ข้อมูลตามความจริงของผูส้ มัคร เพื่อส่งเสริมครูให้เป็นแบบอย่างที่ดีต่อสังคม
ด้วยการรับรองผู้ส่งผลงานครูดีไม่มีอบายมุข ปีที่๑๒ (รุ่นติดตามความเพียร) ตามจริงในพฤติกรรมดังนี้
ไม่ดื่มเหล้า เบียร์ ไม่สูบบุหรี่ ไม่เล่นพนันทุกรูปแบบ และช่วยเหลือผู้อื่นให้ปลอดอบายมุข
และท่านยินดีให้คณะกรรมการติดต่อสอบถามข้อมูลเพิ่มเติมของผู้สมัครจากท่านได้

ผู้รับรองสาหรับผูส้ มัครประเภท ครู

ผู้รับรองคนที่ ๑ ข้าพเจ้าขอรับรองว่า (ชื่อ-สกุล ผู้ส่งผลงาน)................................................................................................
เป็นผูส้ มควรได้รับการยกย่องให้เป็นครูดีไม่มีอบายมุข พ.ศ.๒๕๖๕ ปีท๑ี่ ๒ (รุ่นติดตามความเพียร)
ด้วยเหตุผล…………………………………………………………………………………………………………………………………………………………………
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ลงชื่อผู้รับรอง……………………………………….........…………………..
(…………………………………………………………………..........…………)
ตาแหน่ง.................…...........................................................................หมายเลขโทรศัพท์ ………………………….........…………….
วันที…่ ……/…………………...................../…………………………
ผู้รับรองสาหรับผูส้ มัครประเภท ครู
ผู้รับรองคนที่ ๒ ข้าพเจ้าขอรับรองว่า (ชื่อ-สกุล ผู้ส่งผลงาน)................................................................................................
เป็นผู้สมควรได้รับการยกย่องให้เป็นครูดีไม่มีอบายมุข พ.ศ.๒๕๖๕ ปีท๑ี่ ๒ (รุ่นติดตามความเพียร)
ด้วยเหตุผล……………………………………………………………………………………………………………………….....................…………………….
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ลงชื่อผู้รับรอง……………………………………….........…………………..
(…………………………………………………………………..........…………)
ตาแหน่ง.................…...........................................................................หมายเลขโทรศัพท์ ………………………….........…………….
วันที…่ ……/…………………...................../…………………………
27
โปรดศึกษาเอกสารให้ครบทัง้ ๓ชุดในการสมัคร / เอกสาร๑คาชีแ้ จง / เอกสาร๒ ใบสมัคร / เอกสาร๓ อบายมุข ๖
 เอกสาร ๒ ใบสมัคร

โปรดกรอกข้อมูล ด้วยลายมือตนเอง ตัวบรรจง ให้ครบทุกข้อด้วยความซื่อสัตย์สุจริต

ผู้รับรองสาหรับผูส้ มัครประเภท ครู

ผู้รับรองคนที่ ๓ ข้าพเจ้าขอรับรองว่า (ชื่อ-สกุล ผู้ส่งผลงาน)...........................................................................................
เป็นผู้สมควรได้รับการยกย่องให้เป็นครูดีไม่มีอบายมุข พ.ศ.๒๕๖๕ ปีท๑ี่ ๒ (รุ่นติดตามความเพียร)
เพราะ………………………………………………………………………………………………………………………………….......…..............……………….
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ลงชื่อผู้รับรอง……………………………………….........…………………..
(…………………………………………………………………..........…………)
ตาแหน่ง.................…...........................................................................หมายเลขโทรศัพท์ ………………………….........…………….
วันที…่ ……/…………………...................../…………………………
ผู้รับรองสาหรับผูส้ มัครประเภท ผู้บริหารสถานศึกษา
ผู้รับรองคนที่๑ ข้าพเจ้าขอรับรองว่า (ชื่อ-สกุล ผู้ส่งผลงาน)..........................................................................................
เป็นผู้สมควรได้รับการยกย่องให้เป็นครูดีไม่มีอบายมุข พ.ศ.๒๕๖๕ ปีท๑ี่ ๒ (รุ่นติดตามความเพียร)
เพราะ…………………………………………………………………………………………………………………………………………………...........….......
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ลงชื่อผู้รับรอง…………………………..……………………......…………..
(…………………………………..................………………………......……)
ตาแหน่ง…..............................................……………………....................... หมายเลขโทรศัพท์ ……....……………………….....…………
วันที…่ ……/…………………...................../……………....……………
ผู้รับรองสาหรับผูส้ มัครประเภท ผู้บริหารสถานศึกษา
ผูร้ ับรองคนที่ ๒ ข้าพเจ้าขอรับรองว่า (ชื่อ-สกุล ผู้ส่งผลงาน).............................................................................................
เป็นผู้สมควรได้รับการยกย่องให้เป็นครูดีไม่มีอบายมุข พ.ศ.๒๕๖๕ ปีท๑ี่ ๒ (รุ่นติดตามความเพียร)
เพราะ…………………………………………………………………………………………………………………………………………………...........….......
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ลงชื่อผู้รับรอง…………………………..……………………......…………..
(…………………………………..................………………………......……)
ตาแหน่ง…..............................................……………………....................... หมายเลขโทรศัพท์ ……....……………………….....…………
28
โปรดศึกษาเอกสารให้ครบทัง้ ๓ชุดในการสมัคร / เอกสาร๑คาชีแ้ จง / เอกสาร๒ ใบสมัคร / เอกสาร๓ อบายมุข ๖
 เอกสาร ๒ ใบสมัคร

วันที…่ ……/…………………...................../……………....……………
โปรดกรอกข้อมูล ด้วยลายมือตนเอง ตัวบรรจง ให้ครบทุกข้อด้วยความซื่อสัตย์สุจริต
ผู้รับรอง สาหรับผู้สมัครประเภท ผู้บริหารสถานศึกษา
ผูร้ ับรองคนที่ ๓ ข้าพเจ้าขอรับรองว่า (ชื่อ-สกุล ผู้ส่งผลงาน).............................................................................................
เป็นผู้สมควรได้รับการยกย่องให้เป็นครูดีไม่มีอบายมุข พ.ศ.๒๕๖๕ ปีท๑ี่ ๒ (รุ่นติดตามความเพียร)
เพราะ…………………………………………………………………………………………………………………………………………………...........….......
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ลงชื่อผู้รับรอง…………………………..……………………......…………..
(…………………………………..................………………………......……)
ตาแหน่ง…..............................................……………………....................... หมายเลขโทรศัพท์ ……....……………………….....…………
วันที…่ ……/…………………...................../……………....……………
ผู้รับรองสาหรับผูส้ มัครประเภท บุคลากรทางศึกษา
ผู้รับรองคนที่ ๑ ข้าพเจ้าขอรับรองว่า (ชือ่ -สกุล ผู้ส่งผลงาน)..........................................................................................
เป็นผู้สมควรได้รับการยกย่องให้เป็นครูดีไม่มีอบายมุข พ.ศ.๒๕๖๕ ปีท๑ี่ ๒ (รุ่นติดตามความเพียร)
เพราะ…………………………………………………………………………………………………………………………………………………...........….......
…………………………........................................................................................................................................................................
......................................................................................................................................................................................................
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ลงชื่อผู้รับรอง…………………………..……………………......…………..
(…………………………………..................………………………......……)
ตาแหน่ง…..............................................……………………....................... หมายเลขโทรศัพท์ ……....……………………….....…………
วันที…่ ……/…………………...................../……………....……………
ผู้รับรองสาหรับผูส้ มัครประเภท บุคลากรทางศึกษา
ผูร้ ับรองคนที่ ๒ ข้าพเจ้าขอรับรองว่า (ชื่อ-สกุล ผู้ส่งผลงาน).............................................................................................
เป็นผู้สมควรได้รับการยกย่องให้เป็นครูดีไม่มีอบายมุข พ.ศ.๒๕๖๕ ปีท๑ี่ ๒ (รุ่นติดตามความเพียร)
เพราะ…………………………………………………………………………………………………………………………………………………...........….......
………………………………………………………………………………………………………………………............…………………………………......….
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ลงชื่อผู้รับรอง…………………………..……………………......…………..
(…………………………………..................………………………......……)
ตาแหน่ง…..............................................……………………....................... หมายเลขโทรศัพท์ ……....……………………….....…………
29
โปรดศึกษาเอกสารให้ครบทัง้ ๓ชุดในการสมัคร / เอกสาร๑คาชีแ้ จง / เอกสาร๒ ใบสมัคร / เอกสาร๓ อบายมุข ๖
 เอกสาร ๒ ใบสมัคร

วันที…่ ……/…………………...................../……………....……………
โปรดกรอกข้อมูล ด้วยลายมือตนเอง ตัวบรรจง ให้ครบทุกข้อด้วยความซื่อสัตย์สุจริต

ผู้รับรองสาหรับผูส้ มัครประเภท บุคลากรทางศึกษา

ผูร้ ับรองคนที่ ๓ ข้าพเจ้าขอรับรองว่า (ชื่อ-สกุล ผู้ส่งผลงาน).............................................................................................
เป็นผู้สมควรได้รับการยกย่องให้เป็นครูดีไม่มีอบายมุข พ.ศ.๒๕๖๕ ปีท๑ี่ ๒ (รุ่นติดตามความเพียร)
เพราะ…………………………………………………………………………………………………………………………………………………...........….......
………………………………………………………………………………………………………………………............…………………………………......….
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......................................................................................................................................................................................................
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ลงชื่อผู้รับรอง…………………………..……………………......…………..
(…………………………………..................………………………......……)
ตาแหน่ง…..............................................……………………....................... หมายเลขโทรศัพท์ ……....……………………….....…………
วันที…่ ……/…………………...................../……………....……………

“ครูดีไม่มีอบายมุข ที่ซ่ือสัตย์สจุ ริตเป็ นครูท่ชี าติตอ้ งการ”

30
โปรดศึกษาเอกสารให้ครบทัง้ ๓ชุดในการสมัคร / เอกสาร๑คาชีแ้ จง / เอกสาร๒ ใบสมัคร / เอกสาร๓ อบายมุข ๖