______________________________ Formularul interdepartamental tipizat nr.

MR 2
unitatea
Aprobat de D.S. al Republicii Moldova
Prin Hotrrea nr. 01 din 10.01.97

10.01.97 01

Cod CDUM 030133

FIA PERSONAL Nr._____________________ Nr. Cod
Nr.matricol
document Sex B/F
DATE GENERALE

1.
/
Cod pentru prelucrarea automat

prelucrarea

1. Numele____________________________________ 8. Vechimea n munc

Prenumele__________________________________ general___________________________________

Cod pentru
2. Data naterii________________________________ nentrerupt________________________________

automat

____________________________________________ ___________________________________________
ziua, luna, anul , , 9. Ultimul loc de munc, funcia__________________
3. Locul naterii_______________________________ .
()
____________________________________________ ___________________________________________
4. etenia__________________________________ data i motivul concedierii

5. Studii_____________________________________ 10. Starea civil______________________________
superioare,medii,medii speciale, primare se indic componena familiei
,, ,
)__________________________________________ ___________________________________________
denumirea instituiei de nvmnt superior anul naterii fiecrui membru al familiei

____________________________________________ 11.________________________________________
data absolvirii
12.________________________________________
b)__________________________________________
denumirea colegiului, data absolvirii 13.________________________________________
,
____________________________________________ 14.________________________________________
denumirea colii profesionale, data absolvirii
,
15. Paaport:seria________nr.__________________
____________________________________________
:
c) forma de nvmnt _________________________
de zi, seral
, Emitent ________________________________
____________________________________________
far frecven
Data
6. Specialitatea obinut_________________________ eliberrii________________________________
pentru absolveni

____________________________________________ 16. Domiciliul________________________________
instituiilor de nvmnt
___________________________________________
7. Calificarea obinut___________________________
Tel:_____________________________________
Diplom/certificat nr._________din________________ :
()
____________________________________________ Semntura:_______________________________
Data completrii _______________________________

2.INFORMAII DESPRE EVIDENA MILITAR

Grupul de eviden____________________________ Specialitatea militar___________________________
-
Categoria de eviden__________________________ Apt pentru serviciul miliar_______________________

Efectivul_____________________________________ Denumirea comisariatului militar la locul de
C trai_________________________________________
Gradul militar_________________________________
St la eviden special nr.______________________

 3. NUMIRI I TRANFERURI 4.Concedii

Semntura Durata concediului

Catego- titularului Perioada
Secia (atelierul) Specialitatea ria (retribuia carnetului de
Felul
Sectorul (funcia) tarifar) de munc munc
Data Temei concediului Temei

()

() de la Pna la

()
c

5. INFORMAII SUPLIMENTARE OD

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