SoYeuLyLich

H o to: Chnh quy: Ti chc: Chuyn tu:

Khc, c th l:

Thi gian kho hc: tn

Trng o to:

Chuyn ngnh 2 (nu c):

Bng loi: Xut sc: Gii: Kh: Trung bnh:

Khc, c th l:

H o to: Chnh quy: Ti chc: Chuyn tu:

Khc, c th l:

Thi gian kho hc: tn

Trng o to:

22. Cc kho o to:

Trnh Ngoi ng:

Anh vn:

Ngoi ng khc:

24. Qu trnh cng tc:

25. L lun chnh tr:

Cao cp: Trung cp: S cp: Cha:

26. Thi ua khen thng:

Nm 2000:

Nm 2001:

Nm 2002:

27. K lut:

II. QUAN H GIA NH

28. H v tn cha:Nm sinh:

Qu qun:

Ni hin nay:

Ngh nghip:

Qu trnh cng tc:

Trc 30/04/1975:

Sau 30/04/1975:

29. H v tn m:Nm sinh:

Qu qun:

Ni hin nay:

Ngh nghip:

Qu trnh cng tc:

Trc 30/04/1975:

Bng loi: Xut sc: Gii: Kh: Trung b

Khc, c th l:

H o to: Chnh quy: Ti chc: Chuyn tu:

Khc, c th l:

Nm tt nghip:

Trng o to:

Cc kho o to nng cao trnh chuyn mn nghip v:

Sau 30/04/1975:

30. H v tn anh, ch, em rut: nm sinh? v ang lm g? hin nay u?

31. H v tn v (chng) v cc con: nm sinh? v ang lm g? hin nay u?

Ti xin cam oan nhng li khai trn l ng s tht. Nu c g sai tri ti hon ton chu trch nhim trc Cng ty v php lut Nh nc.

XC NHN CA CHNH QUYN

A PHNG , Ngy thng nm 200

NGI KHAI

CNG HO X HI CH NGHA VIT NAM

c lp T do Hnh phc

S YU L LCH

I. THNG TIN C NHN

H v tn khai sinh:

H v tn thng dng:

Gii tnh: Nam N

Ngy sinh:Ni sinh:

Dn tc:Tn gio:

S CMND:..Ngy cp.Ni cp.

Qu qun:

Ni ng k h khu thng tr:

Ni hin nay:

Thnh phn gia nh xut thn:

Trnh vn ho:H: Ph thng B tc vn ho:

Chc danh/chc v hin nay:

n v cng tc:

Ngy nhp ng:Ngy xut ng:

Cp bc trc khi xut ng:

i tng chnh sch:

Con lit s:

Thng binh: Hng 1/4: Hng 2/4: Hng 3/4: Hng 4/4:

Bnh binh: Hng 1/3: Hng 2/3: Hng 3/3:

Khc, c th l:

ng vin: Cha D b: Chnh thc: Ngy vo

Ngy vo c quan Nh nc:

Ngy vo lm vic ti Cng ty:

Ngy vo lm vic trong ngnh Du kh:Ti n v:.

Trnh chuyn mn:

Chuyn ngnh 1:

Bng loi: Xut sc: Gii: Kh: Trung bnh:

Khc, c th l:

nh 4X6