ใบสมครเขารบการศกษาหลกสตร วทยาลยการทพเรอ กรมยทธศกษาทหารเรอ รนท“ ”

๕๐

๑. รายละเอยดสวนตว สำาหรบคณะกรรมการ ฯ

ชอ (นาย/นาง/นางสาว)..........................................................นามสกล....................................................

NAME ( Mr./Mrs./Miss ) ตวพมพใหญ..................................................................................................

SURNAME ตวพมพใหญ............................................................................................................................

ทอยปจจบน.....................................................................................................................................................................................................................................................รหสไปรษณย...............................................

โทรศพท.....................................................................โทรศพทเคลอนท.....................................................

โทรสาร...........................................จดหมายอเลกทรอนกส (E-mail).....................................................วนเดอนปเกด.......................................................สถานท

รปถาย ๒”ถายไมเกน ๒ เดอน ไมสวม

หมวกไมสวม

เกด.....................................................................

อาย..................ป เชอชาต............................สญชาต.............................. ศาสนา...............................

บตรประชาชนเลขท...........................................วนออกบตร.........................วนหมดอาย......................

สถานทออกบตร............................................................................................................................................บตรประจำาตวเจาหนาทของรฐ/รฐวสาหกจ เลขท....................................วนหมดอาย.....................

สถานทออกบตร............................................................................................................................................ชอบดา................................................................ชอมารดา..........................................................................

ชอคสมรส............................................................อาย.................ป สถานททำางาน............................................................................................................................................................................................................ชอบดาคสมรส....................................................ชอมารดาคสมรส............................................................

ขนเงนเดอนระดบ.........................................................รบเงนเดอน..................................................บาท

เงนเพมพเศษอน ๆ........................................................................................................................................

- ๒ -

๒. ประวตการศกษา

ประเภทการศกษา

ตงแต พ.ศ.

ถง พ.ศ.

สถาบนการศกษา

วฒทไดรบ

วชาเอก สำาหรบคณะกรรมการฯ

มธยมศกษา

อาชวศกษา

อดมศกษา

อน ๆ

๓. ประวตการทำางาน

๓.๑ การทำางานในปจจบนสำาหรบ

คณะกรรมการฯ

ตำาแหนง....................................................................................................................................ชอหนวยงาน/องคกร................................................................................................................ลกษณะ/ประเภท.....................................................................................................................ท

อย..........................................................................................................................................โทรศพท................................................................โทรสาร.......................................................ลกษณะงานและความรบผดชอบของผสมคร (ใหกรอกและแนบรายละเอยดโดยสงเขปเกยวกบธรกจประกอบการทดำาเนนการอยในปจจบน) .............................................................................................................................................................................................................. ..........................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................

- ๓ -

กรณาเขยนผงโครงสรางองคกรของหนวยงานผสมครในปจจบน พรอมทงระบตำาแหนงของผสมครในโครงสรางและจำานวนพนกงานในโครงสราง

สำาหรบคณะกรรมการฯ

ตำาแหนงอน ๆ ในปจจบนทสำาคญสำาหรบ

คณะกรรมการฯ

ตำาแหนง............................................................................................................................ ชอหนวยงาน/องคกร........................................................................................................ ลกษณะ/ประเภท.............................................................................................................. ตำาแหนง............................................................................................................................ ชอหนวยงาน/องคกร......................................................................................................... ลกษณะ/ประเภท.............................................................................................................. ตำาแหนง............................................................................................................................ ชอหนวยงาน/องคกร........................................................................................................ ลกษณะ/ประเภท.............................................................................................................

ตำาแหนง............................................................................................................................ ชอหนวยงาน/องคกร....................................................................................................... ลกษณะ/ประเภท............................................................................................................. ตำาแหนง............................................................................................................................ ชอหนวยงาน/องคกร......................................................................................................... ลกษณะ/ประเภท..............................................................................................................

- ๔ -

๓.๒ ประวตการทำางาน (สามารถแนบเอกสารเพมเตมได) ระบประวตการทำางานทสำาคญจากปจจบนเรยงลำาดบยอนหลงการทำางานทผานมา

ชอหนวยงาน ประเภทหนวยงาน

ระยะเวลา

ตำาแหนง ลกษณะงาน สำาหรบคณะกรรมการฯ

๔. ประวตการฝกอบรม/ดงาน

หลกสตร/ดาน สถานฝกอบรม

ประกาศนยบตร

ระยะเวลา สำาหรบคณะกรรม

การฯ

๕. ความรความสามารถพเศษ สำาหรบคณะกรรมการฯ

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.......................................................................๖. งานอดเรก..................................................................................................................................................................................................................................................................................................๗. ความสนใจพเศษ..................................................................................................................................................................................................................................................................................................

- ๕ -

๘. ผลงานหรอความรบผดชอบของงานทผานมาทมความภาคภมใจ

สำาหรบคณะกรรมการฯ

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(ทานสามารถแนบเอกสารเพมเตม หากมขอความเกนเนอททกำาหนดให)

๙. การเขารวมกจการพเศษหรอกจกรรมทางสงคม สำาหรบคณะกรรมการฯ

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- ๖ -

๑๐. ผสมครมความตงใจอยางไรจงประสงคทจะเขามาศกษาในหลกสตรวทยาลยการทพเรอ

สำาหรบคณะกรรมการฯ

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- ๗ -

๑๑. ผสมครคดวาสามารถนำาความรและประสบการณทไดรบจากหลกสตรไปใชในการสนบสนนภารกจของกองทพและพฒนาประเทศไดอยางไร

สำาหรบคณะกรรมการฯ

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กำาหนดให)

- ๘ -

๑๒. ผสมครจะสนบสนนกจกรรมของกรมยทธศกษาทหารเรอ อยางเปนรปธรรมไดอยางไร

สำาหรบคณะกรรมการฯ

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กำาหนดให)

๑๓. ผสมครจะใหคำายนยนอยางไรตอการเขาศกษาในชนเรยนและกจกรรมทกประการในหลกสตรไดอยางตอเนอง

สำาหรบคณะกรรม

การฯ

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(ทานสามารถแนบเอกสารเพมเตม หากมขอความเกนเนอททกำาหนดให)

- ๙ -

ขาพเจายอมรบวา การคดเลอกเขาศกษาในหลกสตรดงกลาวเปนดลยพนจของคณะกรรมการ ฯ และขาพเจายอมรบการวนจฉยของคณะกรรมการ ฯ ในทกกรณ โดยไมตดใจดำาเนนการใด ๆ ตามกฎหมายทงสน

ขาพเจาขอแสดงความยนยอมวา หากไดเขารบการคดเลอกเขาเปนนกศกษาวทยาลยการทพเรอ กรมยทธศกษาทหารเรอ ขาพเจาจะปฏบตตามระเบยบ กฎเกณฑ และเงอนไขขอกำาหนดของสถาบนฯ หลกสตรการศกษา และเงอนไข การสำาเรจการศกษาทกประการ

ขาพเจาขอรบรองวา ขอความทระบไวในใบสมครนเปนความจรงและครบถวน ขาพเจาทราบดวา หากระบขอความ ทผดจากความเปนจรง จะเปนสาเหตถกตดสทธจากการเปนนกศกษาวทยาลยการทพเรอ หรอถกปลดออกจากการเปนนกศกษา ฯ โดยไมมขอเรยกรองใด ฯ

ลายมอชอ............................................................

(............................................................)

วนท................./................./................

เพอประโยชนในการปฏบตตามพระราชบญญตขอมลขาวสารของทางราชการ พ.ศ.๒๕๔๐ ขาพเจา แจงความประสงคไว ณ ทนวา เอกสารนเปนขอมลสวนบคคลของขาพเจา อนเปนการบงชตวของขาพเจาทอยในครอบครองของกรมยทธศกษาทหารเรอ ในกรณทมผอนมาตรวจสอบ หรอขอคดส ำาเนาเอกสารดงกลาว ขาพเจา

ยนยอม

ไมยนยอม ลายมอชอ.................................................................. (........................................................)

ผสมครทมความประสงคจะนำาเสนอเอกสารเพมเตม โปรดแนบ