Phu luc 1 MA.U PHIEU DANG KY mr TUYEN

(Kem theo Nghi dinh s6 16112018/ND-CP ngay 29thang11 nam 2018 cua Chinh phu)

CQNG HOA XA H()I CHU NGHIA VItT NAM D9c I�p - TIJ do - H;mh phuc

...................... ngay thang nam .

(Dan anh 4x6) (3)

PHIEU DANG KY Dlj TUYEN Vi tri dlJ tuy�o(I>: .

Don v] dlJ tuy�n<2>: .

1. THONG TIN cA NHAN

H ' � N ' th ' - 'nh Q va ten:................................. gay, ang, nam si : ... Nam D Nu D

D� t� T� . ' an 9c:................................... on g1ao: .

S:.. CMND h - Th' - ' � d� N ' :.. N . :.. o o�c e can cuac cong an:..................... gay cap: .. .. .. . .. m cap: .

S:..d.� h i di dc d.i.b,. E ·1 o H;n t 0�1 1 9ng e ao tm:......... . ma1 : .

Q � ' ue quan: .

Ho khau thuong tru: .

Ch6 a hien nay ( dS bao tin): .

Tinh trang sire khoe: , Chi�u cao: ,Can nang: kg

Thanh phan ban than hien nay: .

Trinh d9 van h6a: .

Trinh d9 chuyen mon: Loai hinh dao tao: .

II. THONG TIN DAO T�O

N gay, !hang, Ten truong, Trinh dQ SB hi�u cua Chuyen nganh X�p loai nam cap van CO' SO' dao tao van bing, van bing, dao tao (ghi Nganh Hinh thirc biing, clnrng biing, clnmg .{. •

chirng chi chrrng chi theo bang dao tao dao tao chi chi cap di�m)

III. MIEN THI NGO�I NGU, TIN HQC

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(Thi sinh thuoc dien mien thi ngoai ngtr, tin hoc c!n ghi r5 ly do mien thi a muc nay) Mien thi ngoai ngtr do: .

Mi�n thi tin hoc do: .

IV. DANG KY DV THI MON NGO,;.I NGU (Thi sinh Iva chon va ghi r5 dang ky thi mot trong nam thir tieng: Anh, Phap, Nga,

Trung Quoc, Due hoac ngoai ngfr khac theo yeu c!u cua vi tri du tuyen. Thi sinh duce mien thi mon ngoai ngtr khong phai dien thong tin a muc nay). Dang ky du thi ngoai ngtr: .

V. DOI TU(JNG UV TIEN (neu co)

Toi xin cam doan nhirng loi khai tren cua toi la dung S\I that, Sau khi nhan duce thong bao trung tuyen toi se hoan thien h6 so theo guy dinh. NSu sai su that thi k€t qua tuyen dung cua toi se bi ca quan c6 tharn quyen tuyen dung huy bo, toi se chiu trach nhiern tnroc phap luat va cam kSt khong dang ky tham gia ky tuyen dung kS tiSp tai ca quan tuyen dung.z.

NGUOl VIET PHIEU (Ky, ghi ro ho ten)

Ghi chu: (1) Ghi dung vi tri viec lam dang ky du tuyen; (2) Ghi dung ten CO" quan, t6 chirc, don vi c6 chi tieu tuyen dung; (3) Ngiroi vi�t phieu tich d§.u X vao 6 tirong irng 6 Nam, Nir.

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