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 Tn trng ... ... ... ... ... ... ... ... ... Chuyn ngnh o to, bi dng ... ... ... ... ... ... ... ... ... T thng, nm n thng, nm ./ - ./.. ./ - ./.. ./ - ./.. ./ - ./.. ./ - ./.. ./ - ./.. ./ - ./.. ./ - ./.. ./ - ./.. 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 .......................................................................................................................................................... .......................................................................................................................................................... .......................................................................................................................................................... .......................................................................................................................................................... .......................................................................................................................................................... Ngi khai Ti xin cam oan nhng li khai trn y l ng s tht (K tn, ghi r h tn) ., Ngy thng nm 20. Th trng c quan, n v qun l v s dng CBCC (K tn, ng du)