Mu 2a-BNV/2007

(ban hnh km theo Quyt nh s 06/2007/Q-BNV ngy 18/6/2007 ca B trng B Ni v)

C quan, n v c thm quyn qun l CBCC S hiu cn b, cng chc:

C quan, n v s dng CBCC........................................................................................................

S YU L LCH CN B, CNG CHC
nh mu
(4 x 6 cm)

1. H v tn khai sinh (vit ch in hoa):................................................................

2. Tn gi khc:.....................................................................................................
3. Sinh ngy. thng. nm, Gii tnh (nam, n):..............................
4. Ni sinh: X, Huyn.., Tnh...........................................
5. Qu qun: X., Huyn.., Tnh............................................

6. Dn tc:., 7. Tn gio:....................................................
8. Ni ng k h khu thng tr:..................................................................................................
(S nh, ng ph, thnh ph; xm, thn, x, huyn, tnh)
9. Ni hin nay:.............................................................................................................................
(S nh, ng ph, thnh ph; xm, thn, x, huyn tnh)
10. Ngh nghip khi c tuyn dng:.............................................................................................
11. Ngy tuyn dng: ././.., C quan tuyn dng:..................................................
12. Chc v (chc danh) hin ti:.....................................................................................................
(V chnh quyn hoc ng, on th, k c chc v kim nhim)
13. Cng vic chnh c giao:........................................................................................................
14. Ngch cng chc (vin chc):, M ngch:..................................................
Bc lng:, H s, Ngy hng/.../, Ph cp chc v:., Ph
cp khc:...........................................................................................................................................
15.1. Trnh gio dc ph thng ( tt nghip lp my/ thuc h no):.......................................
15.2. Trnh chuyn mn cao nht:................................................................................................
(TSKH, TS, Ths, c nhn, k s, cao ng, trung cp, s cp; chuyn ngnh)
15.3. L lun chnh tr:, 15.4. Qun l nh nc:..................................
(Cao cp, trung cp, s cp v tng ng)

(Chuyn vin cao cp, chuyn vin chnh,

chuyn vin, cn s.)
15.5. Ngoi ng:, 15.6. Tin hc:....................................................
(Tn ngoi ng + Trnh A, B, C, D,)

(Trnh A, B, C,)

16. Ngy vo ng cng sn Vit Nam .//., Ngy chnh thc://................

17. Ngy tham gia t chc chnh tr - x hi:....................................................................................

(Ngy tham gia t chc: on, Hi,. V lm vic g trong t chc )
18. Ngy nhp ng:././., Ngy xut ng:..//.., Qun hm cao nht:.
19. Danh hiu c phong tng cao nht:.........................................................................................
(Anh hng lao ng, anh hng lc lng v trang; nh gio, thy thuc, ngh s nhn dn, u t,
)
20. S trng cng tc:.....................................................................................................................
21. Khen thng:.., 22. K lut:........................................................
(Hnh thc cao nht, nm no)

(V ng, chnh quyn, on th hnh thc cao

nht, nm no)
23. Tnh trng sc khe:, Chiu cao: Cn nng: kg, Nhm mu:.......
24. L thng binh hng: /.., L con gia nh chnh sch ():.....................................
(Con thng binh, con lit s, ngi nhim cht c da cam Dioxin)
25. S chng minh nhn dn:.. Ngy cp: ../../..................................
26. S s BHXH:..............................................................................................................................
27. o to, bi dng v chuyn mn, nghip v, l lun chnh tr, ngoi ng, tin hc
T thng, nm

Chuyn ngnh o
to, bi dng

n thng, nm

...

...

./ - ./..

...

...

...

...

./ - ./..

...

...

...

...

./ - ./..

...

...

...

...

./ - ./..

...

...

...

...

./ - ./..

...

...

...

...

./ - ./..

...

...

...

...

./ - ./..

...

...

...

...

./ - ./..

...

...

...

...

./ - ./..

...

...

Tn trng

Hnh thc o to

Vn bng, chng ch,

trnh g

Ghi ch: Hnh thc o to: chnh quy, ti chc, chuyn tu, bi dng./ Vn bng:
TSKH, TS, Ths, C nhn, K s......................................................................................................
28. 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, t chc

x hi), k c thi gian c o to, bi dng v chuyn mn, nghip
v,

29. c im lch s bn thn:

- Khai r: b bt, b t (t ngy thng nm no n ngy thng nm no, u), khai bo cho
ai, nhng vn g? Bn thn c lm vic trong ch c (c quan, n v no, a im, chc
danh, chc v, thi gian lm vic)
..........................................................................................................................................................
..........................................................................................................................................................
..........................................................................................................................................................
- Thi gian 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?):
..........................................................................................................................................................
..........................................................................................................................................................
- C thn nhn (Cha, M, V, chng, con, anh ch em rut) nc ngoi (lm g, a ch)?.......
..........................................................................................................................................................
..........................................................................................................................................................
..........................................................................................................................................................
..........................................................................................................................................................
30. Quan h gia nh
a. V bn thn: Cha, M, V (hoc chng), cc con, anh ch em rut
Mi
quan
h

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. V bn v (hoc chng): Cha, M, anh ch em rut

Mi
quan
h

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?

31. Nhn xt, nh gi ca c quan, n v qun l v s dng cn b cng chc

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..........................................................................................................................................................
Ngi khai

., Ngy thng nm 20.

Ti xin cam oan nhng li khai trn y l

ng s tht

Th trng c quan, n v qun l v s dng

CBCC

(K tn, ghi r h tn)

(K tn, ng du)