CNG HA X HI CH NGHA VIT NAM

CNG HO X HI CH NGHA VIT NAM

c lp-T do-Hnh phc

BN KHAI L LCH

D XT TUYN VIN CHC

Phn I: S yu l lch bn thn

1. H v tn:

Nam, n:2. Ngy, thng, nm sinh:3. Ni sinh:4. Qu qun:5. Ni ng k h khu thng tr:6. Dn tc:

Tn gio:7. Ngh nghip:8. Ngy vo on TNCSHCM:9. Ngy vo ng CSVN:

Phn II: Quan h gia nh10. H v tn cha:

Nm sinh:

- Ni ng k h khu thng tr:- Ngh nghip:

- Trc 30/4/1975 (Lm g, u?): .

.

- Hin nay (Lm g, u?): .....

.11. H v tn m:

Nm sinh:

- Ni ng k h khu thng tr:- Ngh nghip:

- Trc 30/4/1975 (Lm g, u?):

.

.

- Hin nay (Lm g, u?):

.

.

12. H v tn anh, ch, em rut (Nm sinh, qua cc thi k lm g, u?): ..

.

.

13. Tnh trng gia nh (c thn, c gia nh): .

.

.

- H v tn v hoc chng (Nm sinh, lm g, u?): ..

.

.

- H v tn cc con: ..

.

.

14. Tnh trng sc kho bn thn hin nay:

15. Tm tt qu trnh hot ng ca bn thn (T 06 tui n nay lm g, u?)

.

.

.

.

.

.

Phn III: Qu trnh o to16. Trnh chuyn mn hin nay:

- tt nghip:

Chuyn ngnh:

- H o to:

- Thi gian o to: Nm tt nghip:

- Tn trng o to:

- Cc lnh vc khc c o to:

17. Thnh tch trong thi k i hc v cng tc (Bng khen, hun, huy chng nu c):

- Khen thng (hnh thc, cp khen thng)

- K lut (cp k lut):

- Tham gia cc hot ng:

.

.

.

.

Nng, ngy thng nm 20.

Ngi khai

(K, ghi r h tn)

CHNG NHN CA CHNH QUYN A PHNG NI CNG DN NG K H KHU THNG TR

nh 3x4