2C/TCTW-98

B THNG TIN V TRUYN THNG

Cc Qun l cht lng

Cng ngh thng tin v truyn thng

S hiu cn b cng chc

S YU L LCH

(nh 4x6)

1) H v tn khai sinh:
Nam/N:
2) Cc tn gi khc:
3) Cp y hin ti:
Chc v:
Ph cp chc v:
4) Sinh ngy:
5) Ni sinh: (thnh ph - tnh)
6) Qu qun: x, huyn, tnh

7)
in thai:

Ni hin nay:

8)

Dn tc:

Cp y kim:

9) Tn gio:

10)

Thnh phn gia nh xut thn:

11)

Ngh nghip bn thn trc khi c tuyn dng:

12)

Ngy c tuyn dng:

13)

Ngy vo c quan hin ang cng tc:

14)

Ngy vo ng Cng Sn Vit Nam: Ngy chnh thc:

15)

Ngy tham gia cc t chc chnh tr, x hi:

16)

Ngy nhp ng:

Ngy tham gia cch mng:

Ngy xut ng:

Qun hm, chc v cao nht (nm):

Trnh hc vn:
Gio dc ph thng:
Hc hm, hc v cao nht:
L lun chnh tr:
Ngoi ng:
17)

Cng tc chnh ang lm: Kim nh cng trnh vin thng

18)
Ngch cng chc: Chuyn vin chnh
(M s:)
Bc lng:
h s: t thng
Bc lng: h s: t thng
19)

Danh hiu c phong (nm no):

20)
S trng cng tc:
Cng vic lm lu nht:
21)

Khen thng:

22)

K lut:

23)

Tnh trng sc kho:

Cao

Cn nng: kg

Nhm mu:
1

24)

S CMND:

25)

o to bi dng v chuyn mn, nghip v, l lun chnh tr, ngoi ng:

Thng binh loi:

Ngnh hc hoc
tn lp hc

Tn trng

26)

Gia nh lit s:

Thi gian hc

Hnh thc
hc

Vn bng, chng
ch, trnh g

Tm tt qu trnh cng tc:

T thng, nm
n thng, nm

Chc danh, chc v, n v cng tc (ng, chnh quyn, on th)

27)

c im lch s bn thn:
a) Khai r: b bt, b t (t ngy thng nm no n ngy thng nm no, u), khai bo cho ai,
nhng vn g : .
b) Bn thn c lm vic trong ch c (c quan, n v no, a im, chc danh, chc v, thi gian
lm vic): .
28)
Quan h vi nc ngoi:
a) Tham gia hoc c quan h vi cc t chc chnh tr, kinh t, x hi no nc ngoi (lm g, t
chc no, t tr s u,) :
29)
Quan h gia nh:
a) V bn thn: B, m, v (chng), cc con, anh ch em rut
Quan
h

b)
Quan

H v tn

Nm sinh

Qu qun, ngh nghip, chc danh, chc v, n

v cng tc, hc tp, ni (trong, ngoi nc):
thnh vin cc t chc chnh tr, x hi,

B, m, anh ch em rut bn v :
H v tn

Nm sinh

Qu qun, ngh nghip, chc danh, chc v, n

2

v cng tc, hc tp, ni (trong, ngoi nc):

thnh vin cc t chc chnh tr, x hi,

30)

Hon cnh kinh t gia nh:

-

Thng/Nm

Qu trnh lng ca bn thn:

10/1993

11/1996

11/1999

11/2002

11/2005

11/2007

Ngch/bc
H s lng
-

Ngun thu nhp chnh ca gia nh (hng nm):

+ Lng: 000 ng/thng

+ Cc ngun khc:
+ Nh :
* c cp, c thu, loi nh:
* Nh t mua, loi nh:
+ t : khng
* t c cp:

tng din tch s dng:

tng din tch s dng: m2
* t t mua:

+ t sn xut, kinh doanh: (Tng din tch t c cp, t mua, t khai ph) :

Ngi khai
Ti xin cam oan nhng
li khai trn y l ng s tht
(K tn)

Ngy
thng
nm 200
Xc nhn ca c quan qun l