CNG HO X HI CH NGHA VIT NAM

c lp - T do - Hnh phc

S YU L LCH
PHN I: LCH S BN THN
01. H v tn: .............................................................................
02. Ngy, thng, nm sinh:. ...Gii tnh:......................
nh 3x4

03. Ni sinh:................................................................................
04. H khu thng tr:..............................................................
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05. Dn tc:....................................................Tn gio: .......................................

06. Thnh phn gia nh xut thn: .......................................................................
07. Ngh nghip bn thn trc khi c tuyn dng: .........................................
08. Ngy vo on:............................... Ngy vo ng: ...................................
09. Trnh chuyn mn c o to:
Chuyn ngnh o to: ....................................................................................
Ti trng hoc c s o to:.........................................................................
Nm tt nghip:................................................................................................
10. Ngoi ng:.Trnh :
11. Trnh tin hc: ..............................................................................................
12. Trnh L lun chnh tr: ..............................................................................
13. Tnh trng sc kho:......................Chiu cao:..............Cn nng: .................
14. i tng hng chnh sch: ..........................................................................
15. Khen thng, k lut (nu c): .......................................................................
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16. Qu trnh bn thn (tm tt t 12 tui n nay, lm g, u?) .....................
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PHN II: QUAN H GIA NH
17. H v tn cha:..........................................................Nm sinh: ......................
Ngh nghip trc v sau 30/4/1975:
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H khu thng tr: ........................................................................................
18. H v tn m: ..........................................................Nm sinh: ......................
Ngh nghip trc v sau 30/4/1975:
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H khu thng tr: ........................................................................................

20. H v tn anh, ch, em rut: (Nm sinh, ngh nghip, n v cng tc, h
khu thng tr)
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Ti cam oan bn khai s yu l lch trn l ng s tht, nu c iu g
khng ng ti xin chu trch nhim trc php lut v li khai ca mnh./.
, ngy thng nm
Ngi khai
(k tn)