Mu s 2/BCBHND

CNG HA X HI CH NGHA VIT NAM

Dn nh mu,
nn trng

c lp - T do - Hnh phc

4 x 6 cm

S YU L LCH
- H v tn khai sinh: .................................................................. Nam/N .................
- H v tn thng gi: ............................................................................................
- Sinh ngy: .................. thng ............... nm ...........................................................
- Qu qun: ............................... .................................... .............................................
- Ni c tr (ni hin nay): ...................................................................................
- S CMND: ...Ngy cpNi cp:... .........
- in thoi: Nh ring:.......................... C quan: ..................... Di ng:.................
- Thnh phn gia nh xut thn: ..............................................................................
- Thnh phn bn thn: .........................................................................................
- Dn tc: ......................................................... Tn gio: ..........................................
- Trnh hc vn: ..................................................................................................
- Trnh chuyn mn: ............................................................................................
- Trnh l lun chnh tr (nu c):..
- Trnh ngoi ng:. ........
- Trnh tin hc:.. ........
- Ngh nghip, chc v: ..........................................................................................
.................................................................................................................................
- Ngch cng chc, vin chc (nu c):M ngch:
- Bc lng (nu c): H s lng:.. Ngy hng....................... .......
- Ph cp chc v (nu c): .......
- Ni lm vic: .........................................................................................................
- Ngy vo ng Cng sn Vit Nam (nu c): ...................;Ngy chnh thc:..........
- Tnh trng sc kho: ..............................................................................................
- Khen thng:; Danh hiu c phong tng cao nht:..

- K lut (ng, chnh quyn, on th): ..................................................................

- L i biu Quc hi kho (nu c) : ............................................................. .......
- L i biu Hi ng nhn dn cp...nhim k (nu c): ..................................
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QUAN H GIA NH
- H v tn cha: .......................................................................... Nm sinh .................
+ Qu qun: ..........................................................................................................
+ Ni c tr: ......................................................................................................
+ Ngh nghip, chc v: ....................................................................................
+ Ni lm vic: ..................................................................................................
+ ng vin (nu c): ........................................................................................
- H v tn m: ........................................................................... Nm sinh ................
+ Qu qun: ............................ ..............................................................................
+ Ni c tr: ......................................................................................................
+ Ngh nghip, chc v:.....................................................................................
+ Ni lm vic: ..................................................................................................
+ ng vin (nu c): ........................................................................................
- H v tn v (chng): .............................................................. Nm sinh ................
+ Qu qun:.......................................................... ................................................
+ Ni c tr: ......................................................................................................
+ Ngh nghip, chc v: ....................................................................................
+ Ni lm vic: ..................................................................................................
+ ng vin (nu c): ........................................................................................
- H v tn cc con, nm sinh, ni c tr, ni lm vic (nu c):..............................
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TM TT QU TRNH CNG TC
T thng ........ nm ...........
n thng ........ nm ............

Lm cng vic, gi chc v, cp bc

g? ti c quan, t chc, n v no?
u?

T thng...........nm.........
n thngnm..
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Ti xin cam oan nhng li khai trn l ng s tht, nu sai ti xin hon
ton chu trch nhim trc php lut.
Chng nhn ca c quan,
t chc, n v ni lm vic hoc
U ban nhn dn x, phng, th
trn ni c tr

Ngy ....... thng ........ nm 2011

K tn
(Ghi r h v tn)