CONG HOA xA HOI CHU NGHIA VIET NAM. . .DQc I~p - Tl}'do - H~nh phuc

BAN TU NHAN XET, DANH GIA cA NHAN. .

H9 va ten:

Ngay, thang, nam sinh:

Chirc vu, chtrc danh:

Thai gian cong tac tai dan vi: (tir thang nam HDLD den nay)

Dan vi dang cong tac: (khoa, phong, trung tam)

I. TVNH~N XET, DANH GIA KET QuA CONG TAc:

1. Chap hanh dU'irng I&i, chu truong, chinh sach cua Dang va phap

Iu~t cua Nha nurrc:

2. Phfim ch§t chinh tr], dao due, I&is&ng, tac phong va I~ I&ilam vi~c:

3. Nang luc, trinh dQ chuyen mon, nghi~p VI):

4. Ti~n dQva k~t qua thuc hi~n nhiern vu :

5. Tinh thfin trach nhiern va ph&i hQ'p trong thuc hi~n nhiern vu:

6. Thai dQ phuc vI) nhan dan, vi~c thuc hi~n cUQcv~n dQng "HQc t~p

va lam theo t§m gurrng dao du'c H6 Chi Minh":

7. Y tlurc tA chtrc ky lu~t:

8. Khen thu'()'ng, ky Iu~t:

- Khen thuong:

- Ky luat:

II. Danh gia chung v~ U'Udi~m, khuy~t di~m trong thiri gian cong tac:

1. Uu di~m:

- Chinh tri, tll' tuang ....

- Trinh d9 chuyen mon, nghi~p Vv ...2. Khuy~t di~m:

III. Chi~u hmmg va tri~n vong phat tri~n:

- Chieu huang phan d~u .

- Tri~n v<;mgphat trien .

v ki~n danh gia ciia lanh d~o(Khoa, phong, trung tam)

Thanh H6a, ngay thang ndm .NgU'Cri tt}' nh~n xet, danh gia

(Ky va ghi ro ho ten)

Thanh H6a, ngay thong ndm ..Thii trU'(rng don vi(Ky va ghi ro ho ten)

Ghi chu: Ban ticnhdnxet danhgia, ddnhmciy cochic14,phong chii TimesNewRoman.

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so Y TE THANH HoAB~NH VI~N DA KHOA TiNH

PHIEU BO SUNG t.t LICH(Tit thang ..Inam din thang ..Inam J

1. HQ va ten khai sinh (viet chir in hoa): .

2. Ngay thang nam sinh: Gioi tinh (Narn/nfr) .

3. Chirc vu (chirc danh) hien tai: .. . .(V~ chinh quyen, Dang, doan th~, k~ ca chtrc vu kiem nhiern)

4. Ngach x~p hang chirc danh ngh~ nghiep wang duong vien chirc: , Mil. ngach: .

5. Bac luang: , H~ s6: Ngay huong / I , Phu dp chirc VI,l: Phu dp khac: .

6. Ngay van Dang ccng san Viet Nam: .1 / , Ngay chinh thirc: / .I .

I. THA Y DOl vi: CHUC DANH, CHUC vu, DON vt CONG TAc(Chi ke khai nhirng thay d6i hoac b6 sung v~ chirc danh, chirc vu, dan vi cong tac so voi thai diem tnroc)

................................ , ..•.••.....•.•..•...•...•••••••••....•...•..•••.••.............•................•.•...........................................................................................................................................................•.•.......................................................................................................

Chirc danh, chirc vu duoc bo nhiern, bau cu, dieu dong, mi~n nhiern (trong dang, chinhquyen, dean th~, t6 chuc cua nuoc ngoai hoac lien doanh voi nuoc ngoai). thay doi v0nQi dung cong vi~c, dan vi cong tac, danh hi~u du'Q'c phong t?ng ...

Tir thang, narnd~n thang, nam

... ···························...··············t···········................•...............................................................................................................................................................................................................................................................................................................................................................

II. DAo T~O, BOI DUONG NANG CAO TRiNH DO CHUYEN MON, NGHI~P Vl)(Chi khai b6 sung sau khi do k~t thuc khoa dao tao, b6i du5ng)

CO' sa dao t~o, b6i Chuyen nganh dao t~o, b6i Thai gian dao t~o, Hinh thuc Van b~ng,du5ng du5ng b6iduang dao t~o, chu'ng chiBD i

... .1 ...... - ... .1 ....--- i

I

... .1 ...... - .... I .....-~-1

... .1 ...... - ... .1 ..... '·-1

.. . .1 ...... - ... .1 .....I

Ghi chu: Hinh thuc hQc: chfnh quy, t~i chuc, chuyen tu, boi du5ng ... ; Van bang TSKH, TS, Ths, Cll' nhan,ky su ...... ho?c chu'ng chi

III. KHEN THUONG (chi khai nhfrng phat sinh rnoi)

.................... , .

. , .

IV. KY LU~ T (chi khai nhfrng phat sinh rnoi)

..............................................................................................................................

... .

V. DI xiroc NGOAI

(T' 6 th ' , I' lnh tf / / d' , / / di r '? f)- I' '"U' ang tro en tin tu ngay...... en ngay...... Inuoc nao. a am viec 0' coquan, t6 chuc nao? N(>i dung cong viec)

..............................................................................................................................

..............................................................................................................................VI. TiNH T~NG SUC KHOE (thai di~m hien tai)

..............................................................................................................................' , .VII. VE KINH TE BAN THAN (nha a, d~t 0' (tu lam, mua, duoc cap, thira k~) va tai san co gia tr] Iankhac theo quy dinh cua phap luat):

VIII. VE GIA DiNH: (ke khai nhfrng phat sinh moi v@s6 hrong va hoan canh kinh t~, chinh tr] cua cacthanh vien trong gia dlnh (b6 my, VQ', chong, cac con, anh chi em ruot...')

IX. NHlJ'NG VAN DE KHAc CAN BO SUNG:

...... " ngay ...... thang ..... nam.....Nglf(Yi khai b8 sung(Ky, ghi ro ho ten)

......... , ngay thang narn .Tho truong don vi

(Ky, ghi ro ho ten, dong ddu)

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CONG HOA xA HOI CHU NGHiA VIET NAM. . .DQc I~p - T" do - Hanh phuc

Thanh Hoa, ngay thang nam 20

DON DANG KY DV TUYEN VIEN CHUC

R9 va ten: Nam, Nil: .Ngay sinh: .Que quan: : .R9 khiu thuong tru: : ,'Ch6 a hien nay: ,Dien thoai lien lac: ..Dan toe: .Trinh d9 va chuyen nganh dao tao: ..Truong: .Chuyen nganh: .D6i nrong uu tien (nSu c6): ..Sau khi nghien ciru diSu kien dang ky d1J tuyen vien chirc cua Benh vien Da khoatinh Thanh Hoa, toi thay co du diSu kien dS tham d1J ky thi tuyen (hoac xet tuyen)vien chirc cua Benh vien. Vi vay, toi lam dan nay dang ky d1Jtuyen vien chirc theathong bao cua Benh vien Da khoa tinh.NSu tnmg tuyen toi se chap hanh cac quy dinh cua Nha mroc va cua Benh vien Dakhoa tinh Thanh R6a.Toi xin dang ky d1Jtuyen nhu sau:1. Vi tri viec lam: .2 M- . ,-. a vt tri: .Toi giri kern thea dan nay h6 sa d1JtuySn, g6m:1. Ban sa ySu ly lich tv thu~t;2. Ban ch\lp cac van b~ng, chUng chi va kSt qua h9C t~p, g6m:•••••••••••••••••••••••••• 0.00 ••••• 0 •• 00 •••••••• 00 ••••••• o. 0 •••••••• 0 •••••••• 0 0 •••• 0.0 ••••••••••••• 0 •

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3. GiAy khai sinh (ban sao hgp l~);4. Gi§y chung nh~n suc khoe;5.02 phong bi (ghi ra dia chi lien l~c), 02 anh c5' 4 x 6.Toi cam doan h6 sa d1JtuySn cua toi la dung S1Jth~t. NSu sai S1Jth~t, kSt qua tuySnd\lng cua toi huy b6 va toi chiu trach nhi~m truac phap lu~t.!.

Kinh aon(Ky va ghi ra h9 ten)