______________________________

Formularul interdepartamental tipizat

unitatea

nr. MR 2

Aprobat de D.S. al Republicii Moldova

Prin Hotrrea nr. 01 din 10.01.97

10.01.97 01

FIA PERSONAL Nr._____________________

DATE GENERALE

Cod pentru prelucrarea automat

1.

1. Numele____________________________________

Prenumele__________________________________

2. Data naterii________________________________

____________________________________________
ziua, luna, anul , ,
3. Locul naterii_______________________________

____________________________________________
4. etenia__________________________________

5. Studii_____________________________________
superioare,medii,medii speciale, primare
,, ,

)__________________________________________
denumirea instituiei de nvmnt superior

030133
Cod
Sex B/F

Nr.matricol

8. Vechimea n munc

general___________________________________

nentrerupt________________________________

___________________________________________
9. Ultimul loc de munc, funcia__________________
.
()
___________________________________________
data i motivul concedierii

10. Starea civil______________________________

se indic componena familiei

___________________________________________
anul naterii fiecrui membru al familiei

____________________________________________

11.________________________________________

data absolvirii

12.________________________________________

b)__________________________________________
denumirea colegiului, data absolvirii
,

13.________________________________________

____________________________________________

14.________________________________________

denumirea colii profesionale, data absolvirii

,

____________________________________________
c) forma de nvmnt _________________________

de zi, seral
,

____________________________________________
far frecven

6. Specialitatea obinut_________________________

pentru absolveni

15. Paaport:seria________nr.__________________
:
Emitent ________________________________

Data
eliberrii________________________________

____________________________________________
instituiilor de nvmnt

16. Domiciliul________________________________

___________________________________________

7. Calificarea obinut___________________________

Tel:_____________________________________
Diplom/certificat nr._________din________________
:
()
____________________________________________
Semntura:_______________________________
Data completrii _______________________________

2.INFORMAII DESPRE EVIDENA MILITAR

Grupul de eviden____________________________

Categoria de eviden__________________________

Efectivul_____________________________________
C
Gradul militar_________________________________

Specialitatea militar___________________________
-
Apt pentru serviciul miliar_______________________

Denumirea comisariatului militar la locul de
trai_________________________________________

St la eviden special nr.______________________

automat
Cod pentru

prelucrarea

Cod CDUM

Nr.
document

3. NUMIRI I TRANFERURI

Data

Secia (atelierul)
Sectorul

Specialitatea
(funcia)

()

()

Categoria (retribuia
tarifar)

()

Temei

4.Concedii

Semntura
titularului
carnetului
de munc

Felul
concediului

Perioada
de
munc

Durata concediului

Temei

de la

Pna la

5. INFORMAII SUPLIMENTARE
OD

__________________________________________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________________________________________
Data i motivul concedierii____________________________________________________________________Ordin Nr.__________________________________________________