‫اﻟﺮﻣﺰ‪..................................‬‬ ‫اﻟﻤﺆﺳﺴﺔ‪..................................................

‬‬

‫ﻣﻨﺤــــــــﺔ اﻟﻤﺮدودﯾــــــــﺔ‬

‫ﻣﻦ‪...........................................‬إﻟﻰ‪.............................................‬‬
‫ﻃﺒﻘﺎ ﻟﻠﻤﺮﺳﻮم اﻟﺘﻨﻔﯿﺬي رﻗﻢ‪ 336-03:‬اﻟﻤﺆرخ ﻓﻲ‪2003/01/15 :‬‬
‫اﻟﻤﻌﺪل واﻟﻤﺘﻤﻢ ﻟﻠﻤﺮﺳﻮم اﻟﺘﻨﻔﯿﺬي رﻗﻢ‪ 194-90 :‬اﻟﻤﺆرخ ﻓﻲ‪1990/06/23 :‬‬

‫اﻟﻠﻘﺐ‪ ....................................................... :‬اﻹﺳﻢ‪.........................................................:‬‬

‫اﻹﻃﺎر‪ ...................................................... :‬اﻟﻮﻇﯿﻔﺔ‪...................................................... :‬‬

‫‪ ‬اﻹﻧﻀﺒـــــﺎط‬
‫‪10‬‬

‫‪ ‬اﻟﻤــــــــﻮاﻇﺒﺔ‬
‫‪10‬‬

‫‪ ‬اﻟﻤﮭــــــــــــﺎرة‬
‫‪10‬‬

‫‪ ‬ﺣﺠﻢ اﻟﻌﻤﻞ اﻟﻤﻘﺪم وﻧﻮﻋﯿﺘﮫ‬

‫‪10‬‬

‫اﻟﻤﺠﻤﻮع ‪<--------‬‬
‫‪40‬‬
‫اﻟﻨﺴﺒﺔ اﻟﻤﺴﻤﻮح ﺑﮭﺎ ‪%30 / ..........:‬‬
‫اﻟﻨﺴﺒﺔ ﺣﺴﺐ اﻟﺠﺪول اﻟﺘﺎﻟﻲ‪:‬‬
‫‪%06‬‬ ‫ﻣﻦ ‪ 20‬إﻟﻰ ‪24‬‬
‫‪%12‬‬ ‫ﻣﻦ ‪ 24.1‬إﻟﻰ ‪28‬‬
‫‪%18‬‬ ‫ﻣﻦ ‪ 28.1‬إﻟﻰ ‪32‬‬
‫‪%24‬‬ ‫ﻣﻦ ‪ 32.1‬إﻟﻰ ‪36‬‬
‫‪%30‬‬ ‫ﻣﻦ ‪ 36.1‬إﻟﻰ‪40‬‬

‫اﻟﻌﻄﻞ اﻟﻤﺮﺿﯿﺔ أو أﺧﺮى ‪.................................:‬ﯾﻮم ‪.‬‬

‫ﻣﻦ‪....................................‬إﻟﻰ‪..........................‬‬
‫ﻣﻦ‪....................................‬إﻟﻰ‪..........................‬‬
‫ﻣﻦ‪....................................‬إﻟﻰ‪..........................‬‬
‫ﻣﻦ‪....................................‬إﻟﻰ‪..........................‬‬
‫ﺗﻮﻗﯿﻊ اﻟﻤﺴﺆول ﻋﻦ اﻟﺘﻨﻘﯿﻂ‬ ‫ﺗﻮﻗﯿﻊ اﻟﻌﺎﻣﻞ‬