thinh You owt f oainsliaugw'

BQ GIAO Due VA DA° TAO ONG HOA XA HO1 CHO NGHIA VICT NAM Dtic lp - Tkr do- Hunh phiic

S6:514 /TB-BODDT Noi, ngety 30 thang 06 nain 2020

TRUONG Di),1 iipc GT V

THONG BAO EN SINH DI HOC TAI NU& CONG HOA DAN C110.

NHAN DAN LAO NAM 2020

su. 4.15 OEN Ngay..... ...... ICU

1)413110.2z__

1 , p -ruic Can c& rib6a,thuan ye ke hoach Op tac girra BO Gide, dye va Dao tao Viet Nam va t "" . B9 Giao due vã The thao nude COng Ma Dan chit Nn dan (CHDCND) Lao nam 2020,

. IrgLITOAikkalrva Dao tao th'Ong bao tuyen sinh di hpc tai mite CHDCND Leo theo dien hoc bong Hiep dinh Elam 2020 nhusau:

APIP /42 1. Thong tin chung ye chtrang trinh h9c bring

Li. SO luvng bye bong, stink 110 ado Igo ve itganh hgc hir

,......„----- TOng s6 c6 60 hoc bOng etao tat) trinh dO dal hoc, thac si YA b6i &rang ngan han tieng Lao (uu tien cac chuyen ngAnh nen nga, van h6a, chinh tri, lich sir, clia bi), Om:

- 05 hpc bong that si;

- 55 11QC bang dai hoc VA hpc bOng dAo tao ngan han tieng Lao (he 02 nam).

1.2. 'IWO gian ado Igo - Chuang trinh dai hoc: 05 nam hoc (bao g6m 01 nam h9c du bi tieng Lao tai nu&

CHDCND Lao dOi voi nguai chin biet tieng Lao);

- Chuang trinh thac si: 03 nam h9c (bao g6m 01 nam hpc du bi tieng Lao tai nuoc CHDCND Lao doi vai nguai chua biet tieng Lao);

- Chuang trinh 1361 du6ng ngan han tieng Lao: 02 nam.

1.3. Chi ao hgc beng

t Clig vien tilling tuyen se ducc Chinh phu Lao cap h9c bong bao Om phi dao no va bo tri ch6 0 Wong ky the xa voi chi phi ap dung theo guy dinh ctia Chinh pliu Lao dOi yeti luu hoc sinh hoc bOng Hiep dinh. Chinh phil Viet Nam cap bit sinh hoat phi hang thang. phi di &rang, le phi !Am t.@ chieu, visa va bao hiem y te theo the dO hien hanh dOi vOi luu hoc sinh dien Hip dinh tai Lao.

2. Doi tuvng, dieu kin WI hti so city tuytn

2.1. Dian hien chung

ling vien chr tuyen can dap (mg d'Ay at cae diau kien chung sau day:

- CO pharn chat chinh tri, ciao dire tot; khOng trong then gian thi hanh k5/ heat hoac trong thai gian dang bi ca (plan c6 thfun quyen xem xtht xir ly k9 luat;

- DO sire khae de h9c tap tai nuat inoai:

- Chin slang k9 du tuyen chtrang trinh hoc bong nao lade tit khi thOng bao nay c6 hieu lye den khi co ket qua so tuyen:

- Cam ket hoan thanh °twang trinh dao tao va tra y6 phtic vp tai co quan Cu di hoe hoac theo yeu eau ciia MA matt. Nhang nguai khong hoAn thAnh chuong trinh dao tap. tcr be hoc, bi buP'e th6i hpc hoac sau khi tot, nghiep khOng tr& ve mite phtic yti, kheng that hien day db nghia \fp dm nguti duct cap hoc bOng phai bOi hoan kinh phi dtlo too theo quy dinh hien Unit;

1

. - Ngenh hy clang ky dcr tuyen phai ,pht11 hop vOi khei nganh clang hyc dai hyc Viet Nam hoc ng'nh. dä dat giüi tinning queie te, khu vvc. quern gin (doi. vai Ong vien bye bong dai h9c), phu hop vai nganh da bye dal hoc, cOng viec dung lam (d6i vai ung vien hoc bong thac si);

- Chi duty 'rang ky 01 nganh hoc va khong dugc thay di nganh hoc, co sor dao tao Sau khi da sang k9 dv tuyen, tiling myth di h9c theo thong bao cila BO Giao cluc va Dao Up Viet Nan. BO Giao dye vi The duo Lao va co sd dao too tai Lao;

- Chi duty ding k* do tuyen trinh (16 dao tao cao hcm trinh do cla cO van bang;

- KhOng xet uyen Umg vien thuOc cac truang hap saw

+ Da tOng ugc co quan Nha nude cir di hgc 0 nuac ngoai nhung khong hoin thanh khOa hoc hod khong thyt hien day âà nghla vy cüa nguai dugc cap hoc bOng;

Dang lam iec tai co quan trong nut nhung khOng co van ban oda co quan ding tac cho Olen do tuy n;

d Da dirge cc co quail. dia phaung trong nu& hoc nude ngoai cap hgc bong di hoc dal hpc. sau cl.i hge,a nuac ngoai, lien co cac rang buOc ve nghia vy, trach nhiem chin &we phOp di oc tie'p 0 ntroc ngoai.

2.2. Doi tuv g vâ diSu kifn dr, tuyin cythi

H QC Ho SO' (illy so biings tly• Dai ttry.ng vu then kien Ey the tuyen bang

tuyen tieng Viet

Hyc bang

di bye

- Hoe si h THPT tOt nghiep trung hoc pho thong nam 2020, co diem tr ng binh chung cila 03 nam h9c ph6 thong dat tl:f 6,5 ht. len; - Sinh v en Elam tha nhat can (Mc dai hoc. hpc vien, truang ddi hoe Vie Nam (he chinft quy thp trung) ea ket qua 03 nam bye THPT a ky 1 nam nhat dal hpc dat tie 6,5 tra len (theo thang di am 10 hoac tuang throng); - Sinh ten clang hoc dv bi tieng Lao nam hoc 2019-2020 tai Truang,i0 al hoc Quoc gia Lao dien ttx tac kinh phi, có van ban dug° tie nhan vat) hoc chuyen nganh narn hoc 2020-2021; - Nguti dung (tug Mc tin Lae co quart nha nutc (trong bien che hoa. hap citing tn, 12 Mang tra len, co clang bao hiem xa b0i), kh ng qua 35 tuoi (01111 den 31/7/2020), tot nghiep trung hgc pH) thong hode tuong throng tit. len. gu tien nguti dang cOng tás tai cdc co quart trung uong, dia phuang cO quan he hop tac di Lao.

Xem chi tiet tai Phu lyc 1

1-1,ye bong

thne si

- Netai CO trial elO dal bye clang ceing tac tai cac ca quan nha nude, cc co sa giao dye dai hgc (bien che hoc hp &mg tit 12 than tit len cei dOng bao hien) x'a hi), kh6ng qua 40 tuoi (tinh crE 31/7/2020), c6 thai gian ding tdc toi thieu 12 thang kE tir kh co hop thing lao dOng dau hen tinh den ngay het ban nop h6 a dv tuyen. Liu hen ngtrai dung cOng tac tai eac co

2

quan trung trong, dia phuang c0 quan he hop tac voi Lao.

- Sinh vien Mt nghiep dui hoc tai Viet Nam vi COng hea clan

thu Nhan clan Lao (trong thiyi nian tir thang 01/2019 den Mang 8/2020) vei ket qua hoc tap dat loui kha tra len, chua co quyet dinh toy& dyng hoac hp <long lam viec, hop clang lao dOng, c6 earn ket sau khi hoan thanh kh6a hgc së ve nuerc lam vie'c theo yeu cau caa Nha mak.

Xem chi tiet] mi Phu loc 2

Bei dutrng ngAn hyn

tieng Lao

Nguai dung cang tac ti cac, co quan nha mak, cac co sa giao doc clai hgc (trong bien che hoac hop citing tir 12 ththng tra len, ce) clang t bao Nem x h0i), khong qua 45 tu6i (tinh den 31 /7/2020), tot nghiep trung hgc phO thong hoac Wang throng tra len, co cong van dr ely tuyen cóa co quan cong Mc. nguei Clang Ong the tai cac co quan trung uong, dia phirong e0 quan he hgp the voi Lao va ngirei clang lam cong toe chuyen intin can sir (long tieng Lao.

Quy trinh nep ha so clang ky tuyen

3.1. 1V(ip lid so' trot' tuygn (online) tni: 11 u p :lit u ven sin h.vied.v

Vie)] phai quet (scan) luu lai loan be h0 so sang cdc files clinh dung PDF (m61 loai tai lieu quet thanh 01 tile rieng dung hang kitting qua 1 MB) de clang k9 troc tuyen.

3.2. NOp ha' so' gidy

ling vien chuyen 03 be hi) so giay chinh thirc clang ky dy tuyen bao gem 01 be bang tieng Viet (danh awe he so chi tiat theo Phy lye I hoac 2) va 02 be bang tieng Anh (danh aloe ITO so chi tiet theo Phy lye 3) bang thu chuyen Oat nhanh bao dam tOi Cye Hy'p tat guile tê - BO Giao dye va DAo tyo, 35 Dyi CO Viet, Quiin Hai BA Trang, HA NW.

HO so can dung trong tüi 116 so Rich thu:Oc 25cm x 34cm, ,10t ngoai ghi day du dicing tin chi tiet theo Phu Ivc I. 2, 3 guy dint) dOi voi hi) so du tuyen h9c bOng dien Hip clinh di hoc tai CHDCND Lao nam 2020.

HO so hgp lelà h6 so ci) dü eac giay to. quy dinh 0 wen, duge nOp trong thai han quy dinh ,cila Thong bdo tuyen sinh (bao gem ca. hi) so online va he) so giay bang tiOng Viet va bang tieng Anh). HQso nep muen se chi clugc xem ;cot ui ly nen vAn can chi tieu hoc b6nn sau khi WI xet tuyen 116 so Ung vien nOp dung hart. Nguel khai hi) so dy tuyen khong dung vã nguti xac nhan sal se bi xCr l theo phap Mat. Coe Hop Mc quoc te kheng tra lai he so va le phi dy tuyen trong bat ky truing hop nap.

(Xem them thOng tin, Mc m'au van ban lien quan tat ccic websites: .www.icd.edu,vn vth www.moet.gov.vn; lien he ho try kjf" thuat khi clang kJ')c1r tuyen theo ilia ehi info@vied.vn, tuvensinh@vied.vn).

Thai hyn nhOn ha so': clen ngay 31/7/2020 (tinh theo ngay Coe Ilgp talc quoe te nhan dugc ht) so va thei nian hoan thanh dang ky online).

, 5. Le phi dip tuyen: 200.000d/nguti, nep tilt& ngay 31/7/2020 theo hinh tht;rc chuyen khoan den dia chi:

Ten don vi: Cpc Hep Mc twee tie SC) Ea; khonn: 0021002145014

' Ngan hang TMCP Ngoui thaang Viet Nam, chi nhdnh Ha NOi.

btu j): Khi huyen tien vao tthi kh9On cita Cuc Hap tac qua(' ta dd ngly ghi r5 lip t'a e 17 allg /? II nh clO clang tuven (D11, ThS, ,TTS) Op le phi du ruyen hoc bong

iwc hi/ CilDcAs ) tau they ThOng 10o no.en .vinh .s.6 /TB-1301)1)T ngthy / /2020.

6. Quy triji 1 xet tuyen

BO Giao dy va Dao tao chi xem xet (mg vien dy tuyen ce, h6,so day (.10 hop le theo quy dinh va cn ca cac tieu,chi tuyen chen se so tuyen (mg vien de chuyen he so cho phia Lao xet duyet, a cap hoc bong. Cyc Hop tac quOc te - BO Giao dpc va Dao tao thong baa ke.t qua so tuye den (mg vien qua email trong thang 8/2020.

(Jug vien ck BO Ciao dye va Dao tuo de ea dime BO Giao dye va 'NO that) Lao duyet cup hoe him: mm i [twee dien tr(luta tuyen va se date BO Ulu) dye ,'El Dao Lao (Cut Hop the quec te) thing bao, hueng thin va giai quyet thU tyc lien quan tiep theo d8 di hoc tai Lao trong thang 9/2020.

Uu tien xem xet (mg vien trong cac trutng hop sau:

Ong vien can (Lao tuo de; be sung nguen nhan lye theo nhu eau sa dung, do cue BO/Niganh va eae dI phtrolig de nghi (c6 van ban de en' dir tuyen va Hop thing earn ket tuyen dung ve cOng the sou khi hoan thanh Rhea flee):

Ung vien doot cae giai thaimg go& t6, khu vtrc va quec gia va cac ang vien khde thee din au ien theo quy che tuyen sinh dal h9c hien hanh;

ting vien tuyen h9c bng thac si cá van ban dm co se dao tao CIA tot nghiep de cis hoc chuyen ti p sinh va ee van ban tip nhan hye thac si eCia Cu SO clao tao tui Lao.

(I) vien ee nhieu MAO tich Ltit trong hoe tap va ren luyen. thanh tich nghien eau khou hoe (the I in qua cue bai bao dang tren tap chi, khoa hoe hoac bao edo tai, h0i nghi khoa hoc cap t utng trO len vá dirge dang trong ky yeu hei nghi hoac tham gia de tai nghien Cali cap BO ira len va de tAi de da duet nghiem thu hoac img dyng).

Nhang truM g hop throe phia Lao tiep nhan khong thuec chaung trial) hoc beng nay. hoac thuOc ch mig trinh hoe bOng nay nhang kliOng dap (mg day eh) clay dinh tuyen ehon ei)a lic) Gino lye va 1.)ao tuo klieng ti ti tuyem (mu HO Citho dye va Dao tao theo dieing baa tuyen sin nay se khOng, throe cup hü ehe do hoc bong coa Chinh phi) Viet Nam.

B6 Ciao dye va Dao to de nghi cac co quan tao diet( kien thuan Igi cho (mg vien cO dO diCu kien can -hiet dime tham gia dtr tuyen dung thei han quy dinh./4,„

Nai nhp: TL. HQ TIWONG - Ole 13O va co quail ng ing 13(5: KU. ( 'ONG CC I-19P TAG ()LOG TE - UBND cae tinh/thanh phi): C V CVC TIWUNG - Cat: so giao dye va da ) tijo, - Cac DH, hoc vin. tramg DH. CD; - BO twang (de b/c); - Các Tha truOng, - ('Ac websitv: www.m et.gov.vn,

1(9 bai: B9 Ghia dye va Dan to Ca quan: 139 Gan dye vet Dio tat Ngay k9: 30-06-2020 17:32:19 +07;00

\A \V%. icd.ed1.1.3'11: 0

- BA° Ciao due va .1-1161 lai: '. 'gttyen Hat Thanh - uric VT. HIQ I.

4

HO SO TUYEN HOC BONG HIV' DINH DI LAO NAM 2020 (Theo thong boo so /TB-BGDDT ngdey,06/2020)

Trinh dO dang dkr tuyfr6n: 1331 HQC

Nganh hyc dang IcY dkr tuyEn•

Fly va ten' Nam. Ni?'

Ngay, Mang, nam sinh'

Truang dang hoc dal hoc tai Viet Nam

Nganh dang h9c dai hoc'

HO khau thuang tro•

Dia chi lien he, s6 dien thoai c6 dinh vá di Ong. (neu

H6 so. dkr so' tuytm (01 130) tiAng tiec ng Vit gm các tai liu trinh bay tren giay kilo A4, theo alien dye trang gray ya zap theo thu tkr duti day:

1. Phieu dang k du tuyen (Mau I); Ban cam ket nghia vu cna luu.h9c sinh duce Lit di hoc nuac ngoai (Mau 2a/2b); Cong van dm ca quan en- du tuyen, Hop Tong cam, ket idly& dung &A vâi truang hop Ung vien chua cOng tac dugc cac ca quan de. cü du tuyen (Mau 7, neu c6); So yeu ly lich c6 dan anh va xac nhan cita UBND phtraing/xa nod cu frit hoc dm ccx s& giao

citic dai hoc dang theo hoc dirge clang dau giap lai va9 drill và cac trang dung quy dinh. Luu ke khai du thong tin. ke ca rripc khen thuang, k luat (Mau 3);

Ban sao cOng chimg giay khai sinh d6i vai (mg vien la nguai dan tOe thieu sO: Ban sac cOng chimg bang t6t nghiep TI iPT hoc giAy chUng nhan tot nghiep THPT; Ban sao cOng chUng hoc ba THPT; Ban sao ding chUng glAy bao duce tuyen thang hoac giAy bao trUng tuyb dai h9c; Ban sao cOng chUng bang diem nam thit nhat dai hoc; Ban sao cong chang bang khen, giAy khen, gray t& chimg nhan cac giai thuang qt.& te,

khu vrc, quec gia,...(nAu c6); Ban sao cOng chimg he) khau thuang trU (cloi vai Ung vien thu6c doi tuvng uu tien vUng.

mien then quy clinh hien, lianh); Bdn sao cOng chUng giay chi:mg nhan con lit si, the thuong binh cUa b6/me de (nett cO); Giay kham sire kh6e ata b'enh vien da khoa cap tinh, thanh ph 0 trong dO xac nhan dü dieu

kin di h9c nutc ngoai; Ban sao cong ch&ng giay chUng minh nhan clan, the can cuac cong dan hoac 110 chieu phi') thong: Ban photocopy hoa don. chime, ve viec n9p le phi chr tuyen; Cac giay to' kith'. (lieu ea).

Lieu 9: Cdc bcin sao phen co xcic nhcin hop le din ca quan co theirn quyen; tn61 logi gidy td• nett nhidu han 01 trang thi phcd c6 ddu glop lai; gidy tà co cinh cdn ducc clang ddu giap lai yew anh. Ong vien dang /th hoc sinh lop 12 khong yeu cdu Op cite gioy tà muc 6,8,9 nhirng phdi Op chi gklytit goon ye ink eng vien tine ec &if neang dirge neyen th (mg ye° cloilve

-TA JALAt

Phn Ine I

Phy lye 2

HO SO TUYEN HQC BONG HItP DINH DI LAO NAM 2020 (Theo thong boo saS# /TB-BGDDT ngay,0/6 /2020)

Trinh dO thing k9 city tu34n: TELSC Si/B61 chrOtng tieng Lao

Nganh ilQC thing k9 dkr tuyen-

Hy va (err Nam, Nit

Ngay, than& nam sinh'

Ca quan cong tac (d6i vâi nguti dang cong tac) hoac co so giao dye vim fat nghi'ep (d6i ngtrosi chaa cong tac).

Nganh hoc da tat nghiep•

khau thutng tra•

Dia chi lien he. s6 din thoai c6 clinh va di Ong, (neu c6)•

Hti so' thy so. Wyk (01 ,be) bang Hang Viet gfis in elle tai lieu trinh bay tren giay kilo A4, theo ehieu dye trang giay Wi up theo th(r ty• duti day:

Phieu dang k dy tuyen (Mau 2); COng van dm co quan ctir dy tuyen, truang hyp ang vien mOi tot nghiep dai hyc chin cOng tac thi nOp ban cam ket ve,v* lam (Mau 4); Hop dOng. carn tcet tuyen citing doi vOi truing hsrp Ong vien chua cOng the &roc clic co quan dC eft dy tuyen ,(Mau 7, neu cO); Ban cam ket nghla vy ctia lull bye sinh (Jaye cir di hyc note ngoai ca xac nhan cija co quart (M5u 2a clei vai ngirei clang cOng tac). co kien bho lanh va chi.) k cUa bO, me hoac ngtrai dai din hgp phdp (Mau 2b) dal vOl nguti chua cOng the); So yeti 19 11th c6 dan anh va xac than ci)a'UBND phuang/xa nai cu tra hoac cfia co so' giao due dai hyc clang theo hyc dugc clang dau giap lai vao anh va cac trang clang guy dinh. Luti Ice khai dt) thOng tin, ke ca mtie khen thuang, ky luat (Mau 3);., Ban sac cong chang cac guyet clinh toyen citing. thuyen choyen ding the, hop (long lam viec, hop clang lac) Ong:

Ban sac cong chang sO bao hiern xa hoi dOl vOl truang hyp ang vien la nguei lao Ong hop d6ng (khang phdi cOng chirc, vien chat) hoac giay xac ri,Nrin clang bao ,hiern xa hQi do co quan cOng tac va co quan bao hiem xa hOi xac than (Mau 7) neu chua dugc cap so bao hiem xa hOi: •

Ban sao cOng chUng bang tat nghiep, bang diem toan khaa dai hyc (truang hop van bang do nuOc ngoiti cap phai nap ban dich cong chimg sang tieng Viet); Ban sao cOng chUng gi,ay ehang nh5n van bung tuong throng do Cyc Quart 1Y chat luong -•13O . Giao dye vO Dao tao cap (d6i voi truOng, hyp tOt nghiep dcii hoc g note ngoai nhung khOng do! BO (Iiao dye va Dao tao cu di hyc hoac tot righiep eac chirong trinh dao tao dai hop phoi hop voi note ngoai thtrc hien tai Viet Nam), , Van ban de cfr. tiep nhan bye chuyen tier) sinh Lilac si dm co sel dao to trong rank va tai Lao (neu co va neu bang ti6ng nude ngoai thi phai nQp ban dich cOng chang sang tieng Viet);

1 I. (flay kham sac khOe cUa benh vin da khoa cap tinh, thenh pho trong do xac than dü dieu kin di hyc nutc ngoai (ca the tham khao va sfr dyng Mau,5); Danh myc cac cOng trinh nghie'n eau cla cOng ho hoac giay cOng nhan (fang trinh nghien cot (neu e6) co xac nhan cua co (pun co warn guyen; Ban sao cOng chang he chieu pho thong: Ban photocopy hea don. chang tcr ye viec nOp le phi dy tuyen;

IS. Cac giAy ta Ichk (neu ca). Lieu )5: ('ac bon sao, ban clich phat co vac nhein hop 10 clio cc pan co fhiim cm :ern; low gi(6•, la net, nhieu hon 01 [rang thi phoi co, &ill glow lai; giely tO cti onh cOn throe eking tut( gic;),) tick, cinh.

Phy lye 3 •

HO SO TIENG ANH DV TUY EN HQC BONG Hip' DINH 13I CHDCND LAO NAM 2020. •

(Theo Dieing bacsa 5J /TB-BGDDT ngay /S /2020 nia 8ç3 Gicio dyc vc) Delo Igo)

Trinh de dang ky thy tuyen (ThS. D11. B6i throng tieng Lao).

NgAnh Ewe thing 45/ thy tuyhy

HQ \fa ten. Nam, Nil-

Ngay, thang, num sinh•

Co quan cons tad-Cruel-1g Clang h9c tai Viet Nam.

Nganh clang 119c dji hoc tai Viet Nam

He khau thuOng

Dia chi lien he, so ten thoi c6 dinh va di clOng, e-mail (nett co).

HO,soi de tuyen (0 be) bang tieng Anh gum cac tai lieu trinh bay Mn gifiy kite A4, theo chieu dee trang gift va xep the() US tty duti dCiy:

I. 'Mien dang k9 tuyen I1QC bang bang tieng Anti (theo m-Au);

Ban dich cang ch(rng hoc 4, bang tet nghiep THPT va bang diem hoc Id I nain thu nIit dal hoc (doi vai ung vien di hoc):

Han ‘lich cOng chirng bang tOi nghiep dai hoe va bang diem tAt ca cac nam hoc di hoc (doi vcxi (rag On iliac .1) Va hang tet nghiep ‘.a bang diem Mac sl, Lien si (doi voi img vien thoc tap sinh):

Bun dich cong chung.giAy khai sinh:

G lay kham khoe cho ngtroi di hoc nu& ngoai (khan) tai benh vin trung irongitinhithanh phO):

Photocopy cac trang can till& cua 110 eh ieu pile thong con gia tri sir dung de di hoc:

flu 'jay to. Rh c (neu c6).

Ltru C'oc ban sou on All final to .v4ic nkin hop Ic cuo to ow.; to ihom quyen: Mai lout gidy Meld how 01/ru phch co clan guip loi: giOy 10 co einh (tin dove (long dam gicip lid veto unit.

PHIEU BANG KY HOC BONG DANH CHO NGliO1 VIET NAM DI IIQC TAI LAO THEO DIEN HIEP DINH

APPLICATION FORM FOR VIETNAMESE STUDY IN LAOS WITH GOVERNMENT SCHOLARSHIPS

(Ph/nu Wing lo5 nay phai &tor dill, bang ding Anh/ This form must be filled out in English )

PHAN 1: THONG TIN CA NHAN/ SECT/ON /: PERSONAL DETAILS

'Fen/ Name HQ/Family Name Ten 0m/Middle Name Tell gcli /First Name

NgAy sink/DOB . .. ... ...

Nai sinhIPlate of Birth

Ngthy/Dqy ThAng/Alomh Ntim/)"co

..

Nutt/Country

Gliti tinh/Gender E Nam/A'/Me

.. ... _____...

Thanh pho/City

NA/lc-emu&

Quil. c tich/Nationality Ton giao/Rellgion

SO hO chiEulPasspori No

Ngay clip/ Issue date

NgAy 0; hnnlExpiry date

NM ctip1Place (ff issue

Tinh (rung him Muth/ Marital Status Doe than/Single 0 Da IC& honlMarried o Ly di/Divorced

Dia chi thutig Ira tai Vitl. Nam/ Permanent Address in Vietnam

Dia chi gili thy tai VI@ Nam (n&ti kluic vai dia chi tharOng tri)/ Postal Address in Vietnam (ildifferent from permanent tide/less)

SO din thoai n ha/Home phone number SO din thoM di Ong/Mobile number

Email 2 Email .1 .

PHAN 2: QUA TRINHHQC TAP/SECTION 2: EDUCATION BACKGROUND

Nam hoc Academic Year

Ca sfr dim IAD Institution

Nganh hyc Field ()J .Study

Bang/Chirng chi Degree/Certificate

: PEIAN 3: QUA TR1NH CON TAC/ SECTION 3: EMPLOYMENT HISTORY

h

Co quan ciing lac/ Employer

Vi tri ding vice! Position iitle

TWA gianrfinte

TirlFrom Den/To —

L._

PHAN 4: THONG TIN Ime • HQC HANG Kt/ SECTION 4: COURSE PREFERENCES DV DINE

IliCing in N, ' khtia hc)c tkii L.Ao/ Course

Khan hoc/Course title c .11io•

Dni Iwo/Bac/it/or n line

preferences in Laos

silMoster

tap sinh/Shori <worse Nganh hyc/ Major

Thoi gian h9cdtudy period

Tal from Den/To

Ngen nil sii.dyng cho khan h9cILanguage used in the course

Trinh do ngoni ngrr/ Language Proficiency

Tien An hlEttglish

o Bat dau/Begiimer o Trung eiipihnermedtate

:;Truirg eat.) cep/ t fpper-Mtertneditne o Neng eau/Advanced

Neu ro loni yen beng/giay oheng nhan trinh do I ieng Anh/ Certificate of English Proficiency

NO

Neu

ngit

6 !oat

khan/ Others

yen bitng/gitly cheng nhan/ Certificate of Proficiency

PHAN 5: THONG TIN LIEN DETAILS

E TRONG TRUONG HOP KHAN CAP/ SECTIONS: EMERGENCY CONTACT

Cung cap thong tin chi (lel cua n contacted in case of an emergen

uti lien he trong trutng hop khan cap1Provide details 0/c, person that can he

119 ten/ Fall Name

Quan he/ Relationship to you

Dia chi lien he/ Correspondent Address

DikTh ilio4i nlia/ Home phone _

pho le Din Ili* di deng/ Mobile

Email

PHAN 6: CAM DOAN/SECTION 6: DECLARATION

Ngdyi lam don xin cam doan:

I.

Ft ca tilting tin toi da cung cap va ghi ô von IA hoan toan °hint) xac.

2. "Frong thei gian hoc hip tAi Lao, t8i xin tuan Ulu Phap luat ctla Chinh phi.i Lao va ni guy quy dinh ciia nha twang.

Liy .viguhig thisi0pm I confirm that:

I. I declare. in submitting this cfflication Arm. that the hilimnatlim contained in it ancl provided in connection with it true and correct.

2. During my study in Laos, I shall abide to the Laos hmw and the University's regulations.

NgaylDate

Ngtriyi thing k9 k terimpplicana'signature

PHIEU BANG la DV TUYEN DI HOC DAI HQC, CAO BANG (111NUOc No:Ai

149c bang du • tuy n: I-19C being NSNN biing Map dint] o tine bang Ithae (law .1". chi clang 10 nu.51 logu

Thong Into tly• tuy en: Nutt dkir tuyen (c ii clang k; 01 amity . Nganh 119c dty tu) an: Ngoyi tin sir dy g h9c 6' flute impale I. H9 \fa ten Glen tinh: o Nam o Ner.

Ngdy, Mang, n m sinh: Gidy CMND/111141 an cute cOng an ser . ....... . Ngny, cap: Noi dip: HO chieu s6: Ng A cap: Not cap:

5, Din chi gtri tht :

Din thoai het he: C6 dinh: Di (Vag: E-mail:

111-BG IMP ligay

.2020

Trinh Li6 hoc vu (eao nhdt): n Trung bye Ph6 thOng 171 C'do clang Qua truth 119c R p:

7.1 Trung bye ph6 Meng: Truing: Diem trung birth h c tap: Lap 10 . Lop 11 Lap 12

Diem tot nghiap "II PT: Xep 16ai 16t ngIiip 7.2. Did hoc/ Cat) LWg: Thai On Ciao [to: am. 'It den

Dai 116c

IELTS 10EFL TCF

"fruang: Nude:

dao Lao: o Cl inh cply Nganh dAn taw Di6m [rung binh h tt.lp vac k3. bye: 8. Trinh (.16 ngoni I gi11r: Ei chicni, chi

XAC NHA CUA CO QUAN COI DV' T YEN (NEU CO) ngety . !hang nom

(Thu in Ong dun vf kpc ghi 15 hy en vet thing Jou)

Chun co chirng chi Ngdy cap: Nai cAp: Ngay cap: Ncri cap. Ngay cap: Nori cap:

ngety . dieing nOtn

Ngtroi dang kj, dty tuyen (Kii vet ghi re3 hy ten)

Tieng Anti: Ting Pap Tieng

Tai chirc o Khdc (ghi r6):

PHIEU BANG Kit DV TUYEN DI HQC THAC Si/TIEN Si/THVC TAP, BO! DVONG O NUOC NGOAI

Rye b6ng dkr tuyen: 1.11 11QC hting NSNN I Rye being iLip dinh El linc bong kluic (Lint S. du clang VinOt loot)

'Dieing bar) dy• tuyen: /TB-BGDD'T ngthy . . /2020 Trinh th, dy' tuy“ (ThS. TS, IT, BD): Neve dkr tuyen (chi clang A.1 I ntrOc).

NgAnh bye thy tuy&l: NgoAi ner siir dung bye O. nut ngoici:

Hy va ten: Giai tinh: o Nam o ND% Ngay, thang, nam sinh: Clay CMND/The can ctrat °kg clan s6: Ngay cap: Nai cap: HI) chieu se: Ngay cap: NM cap: Clitic vki va co. (man clang eong Me:

Thuee BO, Nganh, Tinh: Dia chi g(ri thu:

Dien thoai: Ca quaff Nh rieng:

Di deng: Trinh de ngoai ngit: u C0 ehang chi I Chau co chang chi

Tiang Anh: 1ELTS ToEFL Ngay cAp: Nai

Ting Phap ICE NO)/ cap: Nai cap:

Tieng Ngay cap: Nai cap:

Trinh dti live van (cao nhat): o Dai bye o Thac si Tian si

Qua Milli duo too: 9.1 Dui bye: Lyai hoc being t. Thai gian day tao• nam. 'hr dn

Twang: Ntroc: He clay tap: o Chinh guy o Tai chirc CI Khde (ghi re):

Li Day to phei hop: Ca sO giao due trong ntaae: 'Thai glum M. den

Ca set giao dye ntri:re ngoai: 'Thai gian: t& den

Nganh day taw Diem Ming binh hyc tap than kh6a:, Diem bat) ve Man van tot nghiep (neu co)• LAU tet nghiep (neu CO). (Nau khong phai In Mang diem 10 thi en ghi rO diem bye tap /thang diem (Ma noi bye \fa tinh guy dOl Mang throng sang thang diem 10, kern theo ban say Meng tin chinh thdc ye

thang diem, xe).) loyi cOa nai hyc).

9.2 Thou Logi hoc bang':

Thai gian dao too: nam. TO' den Twang - Nutt: He dao too I) CI inh goy Lb Tai chile • u Khac (ghi ray

D o too pan hop:

C'c sa giao dye ming mite: ihcii gian: tit den C sd gia() dye note ngoai: Thai gian: den

1\iganh dao too - Diem trung binh hue tap toan khoa: Diem bao ve loOn an tot nghiep (neu eb): Logi tat nghiep (nu ea)• • (Neu kliang phai 1 thang diem 1-0 thi ean ghi re.) diem hoe tap /Mang diem cila nn hoc va unh quy , doi Wong doong sang thang diem 10, kern theo ban sac thong tin ehinh thac ye tilting diem, xep Ioi cOa nal hoe).

9.3 Tien si: Logi hoc bong': Thai gian dao too: num. lIr den

11-tutog: Note: He daQ tkio: n CI inh quy o Tai chire o Kb& (ghi rO):

o Di too phi hop: C( sO giao dye trong note: ThOi gian: tir den C sd giao dye note ngorli: Thai gian: den

Nganh,dao too: 10. Nhan Net, dad gia phatn chat do dire, 16i song (do Thu twang co quan eeng tac, co quan. giat thieu dkr tuyen ghi):

XAC NHAN .0A CO QUAN 'Tay (hang luiM

CO. DLITU EN (NEU CO) Ngtveri dAng 14 du. tuyen "gay hang nam (Kji vet ghi ra ha ten)

(Tha inn 7g dun vi k3;, ghi ra 120 IC va Jong Lion)

Chi club Chi 1.5 loyi hyc bOn,czi the' nInt sun (chi cjn didn sO ghl chail (I) Hoc hong do ngd1 sad Min ntrOc ViOt Nam ettp(30 Gino due vã Dao too dr di hoc); (2) Hoc bOng theo cc da an deo to phOi hop divot Bo Ciao dyc vã Dao too cap kinh phi; (. 3) Floc bong didn Hiep dinh (BO Gino dye vil Dno too cO di hoc):

Hoc ,Lning do ea a Ono dye nu& ngoaileu quail. to chOc (woe td cap (ghi rti thin cdp Ina: Ngutin tai try kh c hoac to the kinh phi.

CC/NG HOA X); HOI CHU NGHLA VIrf NAM Dc 10p -Tr do - H4nh plok

BAN CAM KEIT

THI)C HICN NGHIA VI) CIA LIM HQC SINH (danh cho rzgtrai clang cang tac (di ca own, clan vi, dice phtrang)

Kinh gCri: BO Ciao dyc vã Dao tao

Ten toi IA: Sinh ngay

GiAy CMND/The can cuac Gong dan s6: Ngay cap: Ncri cap•

HO chieu s6: Ngay cap: Nai cap:

Hien nay la: Khi &rye Nha Bute cA di bye tyi nuoc ngoni. Col ti; nguyen cam ket thyc hien cac

nghia vi situ:

Chap hanh nghiem tue Quy che quan ly Rio hyc sinh a mite ngodi, guyet dinh cu: di

hpc tha BO Ciao dye va Dao to va chap nhan the guy dinh hien hanh tha Nha note

ve tai chinh. Khong xin chuyen twang. chuyen nirot horje thay d61 khoa hyc. chuang trinh bye.

Cam ket tich cue hyc tap. nghien e(ru &Moan thanh tot chuong trinh dao tyo diing thai

hçtn duve phap. Neu bi buOc th6i hyc se boi hoan kinh phi theo qui dinh cua Nha mint. Neu phial gia

bon thai gian hyc tap se tu tiac kinh phi trong thai gian gia han. Sau khi kat thine khoa h9c va nuac va thye hien thu tyc bay etio tot nizhicip cho BO

Ciao dye va Day to. Cam ket lam viec latt dai cho co guan di EN di bye hoe they sty diau dOng cilia

NM rurac. Tip tyc clang bao him xà hOi trong that gian di hyc & flute ngoai.

Cam ket neu thing tuyen hoc bong cilia cAp se di hyc theo dung Le handl do

yeu cu.

TOi xin cam ket thtre hien day du Inking diau nau trôn va cac guy dinh hien hanh !Mac c6 lien guan. Nati khong thtre hien dung ban earn ket nay, ten xin b6i hoan wan

be‘ chi phi dao to vá hoan toan ehiu trach nhiem v6 viec xes lua't theo cac guy

dinh hien hanh cilia Nha nuac.

ngay thang nam

Nguai earn kat

(k) vex ghi rci hp ten)

Xac nhAn ha° 1 nh etia co. quail tuyen awn sin giOi thieu ngtriri tly• tuyen:

xac IMP No moil ong/ba

n che/hgp dimg) etia t thtre hien trach nhiem: vá b6 tri ding the phi' hop v6i chuyen mon N/A trinh do ciao tAo sau &putt: ngoai

(lieu kin dli3 Ong./N cc") ten tren dupe tiep ttic clang btho him xä hei n di ciao tao 0 mak ng,oai.

eac co quan lien quan trong yiec yeu cüu Ong/ba c6 ten ten Uwe hien am ket neu tren.

ngay thang num "Itut inking /Giam d6c/Hieu tru6ng

(4, ghi r5 hp ten Ve7 dOng ddtt)

hien dang IA (hi .

Chong tot cam k 1. Tiep nhAn la'

khi tot righie 7 . Gh(tp diY.

trOng th6i gi

3. Phi twp vai dung nhilng

ONG HOA XA HOl CHID NGHIA VICT NAM D0c lp - Ty' do - likmh ph tic

BAN CAM 'CET

TH VC HItN NCHIA ODA WU HOC SINH (danh cho ngweri chwa c6 ea quan cong lac)

Kinh 130 Gino dye vA Dao tao

Ten tOi Sinh ngay Giay CMND/The can ctr6c cong clan s6: Ngay cap' Nai cap: HO chieu s6: Ngay cp NCYI cap. Hien nay la: Khi ducec Nha nutc ci:r di hoc tai nuac ngoiti, tôi ty nguyen cam ket thyc hien cac nghia vy saw

Chap hanh nghiem tUc Quy ale quan ly h9c sinh a nut ngoai, quyet dinh eir di hoe cna BO Ciao dye va DAo tao va chap nhan cac quy dinh hien hanh dm NM nutc ve tin chinh. Phiin clan hoc tap, nghien CO'LI cle hoan thanh chuong trinh dao tao thing thOi han.

KhOng xin chuyen trubng, chuyen nuck hoc thay d6i khoa hoc, chuang trinh hoc. Cam ket tich cuc hoc tap. nghien dm a hoan thanh tOt chuong trinh dao tao dimg thoi han throe phep. Neu hi buOc thei hoc se hOi hoan kinh phi theo qui dinh cüa Nha nut. Neu phai gia han thOi gian hoc tap se tu lUc kinh phi trong the(' gian gia San khi ket thac khod hoc ye rank, thuc hien thiIi we bao cao tot righiep cho BO Gido dye va Da° tao WI lam viec lau dai theo sy dieu dOng cUa Nha rarac. Cam Icet neu thing tuyen hoc bong dm cap se di hoe theo dt:ing ke hoach do yen can.

TOi xin cam kat thyc hien day du riliErng diet' nen iron vá cae quy dinh hien hanh khac c6 lien quan. Neu khong thyc hien thing ban cam ket nay, tei xin boi hoan loan 170 chi phi dao tao vá hoan man chin trach nhiem ye viec kY luat theo cite quy dinh hien hanh cna NM nuerc.

rigity thang riam Nguti cam ket va ghi ra 119 ten)

CAM IC El' CO CIA DINH

1-19 \fit ten hi) (mc :

(Ong tile

Dia chi:

di diet cho gia inh ILru he sinh co ten tren. chang toi earn ket

- Nhie MI6% dek vin Itru hoc sinh Owe hien dEiy du nghia vu du dirge guy dinh dOi vol km hoc si

- Cing hat hoc sinh boi hoein .kinh phi d5 chive Nha nuot cap n6u kru bye sinh khong Uwe hien - l'ing cam ket.

ngav thong... .... neon ... HO (Inc)

(k5, va ghi it ha ten)

—mar

Mriu 2c-BNV/2008

Ca Limn. dun vi c6 thrim quyen quart h CBC7C

Ca quan. don vi sir dung CBCC

SO YEU Lt LICH CAN BO, CONG CHIiC

Hg va ten khai sinh (viet cha in boa):

Anh mau Ten ggi khac:

(4 x. 6 cm) Sinh ngav:....hang

Nui sib: XI

narn

Huyen

(Ji6i tmnh (nain,

Tinh

Que quan: Xa , Huyen Tinh

. _ Dun tee:

Ten giao:

Nui Clang ky bO khau thutng tru:

(S6 nha, dutng ph6, thanh ph6. x6m. then, xa, huyen, tinh)

Nai a hien nay:

(S6 nha, clueing ph6, thanh pho, x6m. then, xu. huyen, tinh)

Nghe nghiep khi dirge tuyen dung:

II) Ngay tuyen dtmg: .../.../ ...... tuyen dung:

Chin \iv (chtirc danh) hien tai:

(Ve chinh quyen hoAc Dang, doan the, ke cA chac vv kiem nhiem)

COng viec chinh dtrgc giao:

Ngueli cong chirc (vien chirc): Mu ngnch:

Bac ltrung• He so.: Ngay

Phu cap chirc vv. Phu cap khac:

15.1- Trinh de giao duc pho thong (dä tot nghiep lap may/thuec he nao):

15.2- Trinh de chuyen mon cao nhat:

(TSKH, TS. ThS, ctr nhân, kgr sir, cag dang, &Ling cap. so cap. chuyen nganh)

15.3- 1...Y ItiOn chinh tri: 15.-1-Quan lynba mite:

(Cao cap, trung cap, so cap va tucrng throng) (chuyen vien cao cAp. chuyen vien chink chuy'en vien, can sty

15.5- Ngoni ngir: 15.6-Tin h9c:

(Ten rig* ng(Th Trinh dO A. B. C. D ) (Trinh de A. B. C' )

Ngay vao Bang C6n2. sun Vit't ....... Ngay chinh ......

Ngay tharn gia to chne chinh tri - xa hei:

(Ngay thain gia tO chirc: Doan, Hei vã lam viec gi trong t6 chirc do).

Ngay nhap ...... , Ngay xuat ngir .../,../ ...... Quan ham cao nhat:

Danh hieu dugc phong tang cao unlit

--thuLAC

. . (Anil hung lao dOi g, anh hang lire luong ye trang; uhA gin thay ihuec. nghe si nhan dan va uu té, ...)

20) So trutng col g it:

2 i ) Khen thuirng: 72) Ky hat: thirc cao nh't, nam tido) (ye dang, chinh quyen, (Joan the hinh thtire cao

nhat, nam nao)

TMh trang sO. khoe: Chieu eao: Can nang: kg. Nhem maw La thuong bin hang: ..../ ....... La con gia (huh chinh sach:

(('on thuang binh, con liet si, nguti nhigm chat dc da cam Dioxin)

Se ch(mg Min nit clan: Ngay cap: .1...!....... Se se BHXH:

DEO tgo. bei d trig ye ehuyen mon, nghiep vii,ly luau chinh tn. ngoai ngir, tin hoc

Ten truang Chuyen nganh dao

tao, boi dudng

—I— ' Tir thang, nam - den Chang, nam

Hinh that dao tao

Van bang, 1 chung chi, trinh do _1

/ ,

- /

- /

- /

- I - I

I

I

- I _ I

I

I

- I

- I

Ghi chi: Hinh thi: • dao tao: Chinh quy tai cht:rc, chuyen tu, bei dung ../ Van bang: T'SKH, TS. Ths nhan, Icy str

28) Tem tat qua trinh cong tac

,

Tir Wang nam C'hirc dimh chin: vo. don vi tong tac (dang. chinh quyen. doan . , - '

than& nam CO the, chire xa gian dirge ciao tao, !Gel dudng yechuyen mon, nghiep yu

1

__tour

Dac (hem lich sCr ban than:

- Khai re: bi bat. bi tO (tir ngay tháng nam lido den ngay thang nam nao, a dau), da khai bao cho ai,nhang van de gi? Ban than cO lam viec trong che dO eQ (ca quan, dun vi nao, clia diem. chirc danh, chCrc vv. thai gian lam viec ....)

- Thant gia hoc cO pan he vOi cac to clak chinh tri, kinh te, xä hei nao a nuac ngoai (ldm gi, to chat nao, dat try so. & dau ...... ...?):

- CO than nhan (Cha, Mc. Vq, Cheng, con. anh chi ern met) a nutc ngoai (lam gi, dia chi)?

Quan he gia dinh

a) ye ban than: Cm. Mc, Vg (hoe chOng), cac con. anh chi em ruOt

quan .he M6i Nam

HQ va ten sinh

Que quail, nghe nghie'p, chirc danh, chirc vv. dun vi ding tac. hoc tap, nui 6 (trong, ngoai mite); thanh %/len cac to chtirc chinh

tri - xi-i hOi

_

- -

__AA,ustar

Ngultri k T6i xin cam doan khai tran day la d

(Ky tan, gin re

al nhang lai ng skr that hy ten)

a) Va ban v. 9 (hoki cheng): Cha. Me. anh chi em rut

Mei quan he fic va tan Nam

sinh

Que quan. nghe nghiep. chac danh, ch(rc vki. don vi cOng tac, h9c tap, nal a (trong, ngoai nutc); thanh vien cac ra chac chinh

tri - xa hOi )

31) Dian bin qua

Thanginam

:rinh luong cua can be, cOng chat:

Ma ngach/bac

He s6 lu(yng

32) Nhkin xet, clan g a dm co, quan. don vi qt. an ly (firing can be. cOng chin:

Ngay thang nom

Thfi trutivg co quan, dun vi quail 15/ vã sfr dyng CBCCVC

(K) ten, clang (1610

4

--1AAAJO--

Mk 3

CQNG 110A XA 1191 CHO NGIliA VIVI' NAM DQc 1(ip -Tv. do - liktrth phtic

Anh mau 4x6cm

(c6 citing clan giap lai ctia coa eu quan xac nhan 15,

lich)

YEU Lt LICH 77/77111,)7'

Flo va ten. Nam, MT:

Sinh ngay thang nam

Nai a dang ky he khan thtrang MI hien nay:

Chang minh Etat nhan dan so. Noi cap:

NgAy tháng nam

S6 Dien thoai 11th he: Nha rieng • Di Ong

Kim can bao tin cho ai? 6 au?.

86 higu:

1

Ho vã ten: - 131 danh:

len thaang goi:

Sinh ngay thang num Tai:

Nguyen quail:

Noi clang ky, thaang trU hien nay:

Dan tOc• "len gioo:

Thanh phAn gia dinh sau cai each rueng dat (hoc cai to cong thuang nghiep)

Thanh phan ban than hien nay:

rinh de van hoa• .Ngoai ngir:

Trinh do chuyen men: Loai hinh dao tao

Chuyen nganh dao to:

KM nap Dung cOng san Viet Nam ngay thang nam

ket nap:

Ngay vac) Doan TNCSHCM ngay Mang nam:

Noi ket nap:

Tinh hinh sot khoe• Cao 1m Can nang• kg

Nghenghiep hoac tr nh do chuyen men:

Cap bac• Luting chinh hien nay:

Ngay nhap ngil• Ngay \mit ngil:

Ly do:

HOAN CANH GIA DINH

HQ Va ten be: 'Fuel Nghe nghiep

Truck each mang Thang 8 lam gi'? Udau?

Trong khang (Alien cheng dux clan Phap lam gi? date?

TO' nam 1955 den nay lam gi? 6 au? (Chi re ten co quan, xi nghiep hien nay dang lam)

2

Hp vã ten me. Tuai• Nghê nghiep

Truck each mpg Rang 8 lam gi? dau?

Front?, Bang chi& ch6ng Owe than Phap lam gi? 0 dau?

TO. nam 1955 den nay lam gi? dau? (Ghi 1-6 ten co (pan, xi nghiep hien nay dang lam)

HQ VA TEN ANH CH! EM RUQT

(Ght 10 ten, tudi, cho C); ngh nghiep vá trinh et0 chink tri ctia tawg ngtrat)

3

thang.nam den thang nam

I I9 va ten vg hoc chOiig Tu

Nghe nghiep:

Noi lam .viec:

Cho el hien nay:

HQ va ten °AC con:

1-) • Tuoi: Nghe nghiep:

• Nghe nghiep;

Nghe. nghiep:

Tuai: Nghe nghiep:

TU61: Nghe nghiep:

QUA TRINLI Fiala BONG CIA BAN THAN

Lam con tac gi?

dau?

KHEN THUIONG VA KS? LUA.+T

Gla chirc vg gi?

Khen thuang:

Ky tot

LO1 CAM DOAN

Föi xin cam doan nhilng lói khai tren Iii diing sus thcrc va chit' trach nhiem ve nhtIng lai khai clO. Neu sau nay co quail cO them quyen Oat h* van de gi khong &mg. TOi xin chap hanh bien phap xü ly theo guy dinh./.

Xne nNin efia Thfi trtrang Co quan, Ngtreri khai 14 ten Xi nghiep, Chu tich 1113ND X, Ph thing

miitt 04 ONG HOA XA 1191 C111*1 NG1HA VICT NAM

DOc lap - 14 do - Hanh phtic

, ngay thcing nom

GIAY XAC NHA. N

Kinh gilt' (Tha Inning don vi ngtred lao tiOng dang him vit'c)

Ten toi la: CMND so: Chat danh:

Hien dang lam viec tai:

DOng BHXH tai BHXH:

De nghi don vi xac nh:an cho tot dang tham gia BHXH tai don vi.

L9 do xac nhan:

Xác nhan caa don vi

Nguti de nghl ac UM, citing dam (1(35 1.5 hc (en)

Xãc nhan caa co. quan BHXH (xac nhan den thang dang dQ tien BHXH).

CO QUAN BEIX1-1:

Xac nhan Ong (Ba):

Hien dang tham gia BHXH tCr Chang nam den thang narn

theo ca quan cong tae:

so sO BI-IX11:

17g11.11 !hang ION/

GIArn Doc BHXH

S. XET NGHIEM H t NET HOC, SINN VAT. SINH HOA HW (.11AKOPATOPliblE

30 BM-41A - FEMOTO./0E114ECKHE, 6110-110E1I4ECKHE 6110X11M1111ECKHE

EXAMEN DU SANG. BIOCHIMIQUEBW. VDRL )

X quang (X-rpaquitc Radiographic)

KET LI IAN (3AK,11104EHI4E; CONCLUSION)

.3E-

BOK:

LIEN BO CIAO DEC DAC) TAO - V TE

Man 5

VA HOT DONG CLAM DINH Y KHOA

ME41411,HHCKAH KOMFICCH51

CONSEIL MEDICAL

GIAY CHIINTG NHAN sOt KHOE

MEjallAMICKAM cnPABKA

CERTIFICAT MEDICAL

Anh Mecio XI A

(DOTO

Photo

.( KHOE (II PA HEIECKII 3110P013(A); ETAT DE SANTE)

H9 và tin No,Ay. thing, nam sinh

Nghb. nghi91) Nam, nit

Cti quan

h. DO HAY KHONG DU SO.(' KHOE DE DI HOC (HPAKTINECKH 31tOPOB(A) H 110

COCTOSIFII110 MMKET B6ITE IOW HE AIWICET EbiTh HAFIPAI3J1EH(A) HA YLIElit;

LINTERESSE(E) EST A PTE/INAPTE AUX ETUDES)

Ngay (JLaT2; Date) .thing nam

CHtt TICH 1101 HONG Kt TRUCING DOAN KHAM Kc

IlPEACEDIATEilb KOMMHCCI1I4 rioarma. TJIABH1i111BPA41110111111Cb

VUE ET APPROUYE PAR LE CHEF LE MEDICIN CONSULTANT

DU CONSEIL SANITAIRE SIGNATURE SIGNATURE

TiNH TR,ANG THE WC ((D113114ECKOE COCTOMHIIE; ETAT GENERAL)

Chiêu cao (Poct: Hauter)

Cm nAng (Bec: Poids)

tong no,ot (Oupputtocm rpyin; Petimetre thoracique)

TM ra (Butiox: En expiration)

Hit vio (Wiwi; En inspiration)

Trung binh (Cpeauai; Pignet moyen)

Bic sy- Itham (Bpay; Examinateur)

BENH To- (3AG0.11EBAH1451; MALADIES)

(cm: cm)

(cm: cm)

(ot: cm)

.(1Cr Itg)

(cro: cm)

.4cm: cm)

I. NOI KHOA (ITP.AHEBT; MALADIES INTERNES)

- Thin honn moth (Ilyibc; Appareil cardiovasculaire )

din /phiit (taap/mith; Pouls/min)

- Huy& Up Op c pit about danientte; Tension arterielle )

Ti da (Max: Systolique) tit Nettr.CTOJIU; Mi

Tot thieu (Mutt; Diastolique) MNI/RT.CT011 b; mm/Hg)

-Tim (Cepiue: Coeur)

- Phii (.11erwtte: Poumom)

Bic SS' khim (Bpa9; Examinateur)

- Di day (Wea son: l'estomac) , . ..

Bic sy kinim (Bmu; Examinateur)

TAM THAN. THAN KINN (TICIIXTIATP, HF-BPOHATOJI0r; NEURO-PSYCHIATRES)

Bic sy kham (Bpav; Examinateur)

NGOAI KI-10A (XIIPYPT; MALADIES CHIRURGICALES)

Di mö (Onepaulan Intevention chirurgicale)

Thiyi gian (ana: Date)

- He vin d6ng. ci)t sang (Onormo-usurate.mtian clacTema, cranntort xpeger;

Colonne vertebrale, appareil-locomoteur)

Chi Erin (Belinate noisevuoc-na: Membres superieures)

Chi dada (Hatintaite woven-mem Membres interieures)

- KhOp (CycsaMal: Articulation)

- Suing (Koran; Os)

- Cor iMycKyaarypa: Muscles)

- Tim mich epievno-cocyameraa cues esta: Cardiovasculaire)

- Hiu mon (Ate; Anus)

Tait ni'iu.sinh dye (13biseatt-reabatue ft rassoable opralabn Apparel) ..

lCh6i u (Onyxnain Tumeurs)

Bic sy khitm (Spay; Examinateur)

4. CHU KHOA (CREHHAilbliblE '3A60-fIEBAH1111: EXAMEN DL l MED-ECIN

SPECIALISTE)

- Mit (Taa3a; Acuite visuelle)

Riding kinh (Bea mucosa Sans correction)

Phth (11partbag; Droite) 0.D

Trai (leabiii; Gauche) 0.G

CO kinh (C oviamit; Avec correction)

Phil (flpaablit; Droite) 0.D

Trai (-fleabag; Gauche) 0.G

Bic sykhim (Bpay; Examinateur)

- Tai Mid tieing (0y0napitarasot ORI,)

- Think lac, n6i thutmg 5m (Calyx nail' tiopm. peva 5rit.; Audiometrie I 5m-voix normale)

Tai phai (Hpasoe no: Oreille droite)

Ti traii (lame yxo; Oreille gauche)

Ned thim 0,5m (Dpi. wonoTe 0.5m: Audiometric I 0,5m-N-ois hasse)

Tai phial (Elpasoe yxo; Oreille droite)

Tai trai (.1Iesoe no; Oreille gauche)

- BeMh ye T.M.II (3a6oaesaante yxa, iopia, HOCa: Maladies ORL)

Bic sy kharn (Bpast; Examinateur)

- Ring him mit (Cromasvaor; Dent)

Bic sy kham (Spas; Examinateur)

- Phu khoa (Cimeteonor; Maladies gymecologiques)

Bic sy laham (Bpav; Examinateur)

- Da lieu (aepma-roaor; Maladies dermatovenerologiques)

Bic sy kham (Bpav; Examinateur)

Mu 06

ONC HOA XA HO! CHU NGHIA VICT NAM

DO 14p - Tter do - Hkinh phtic

CAM KET YE VI K LAM

Kinh gni: BO Ciao dyc va lao tyo

Ten tei la - SC) CMIND/HC•

Ngay cap Nai cap-

Dia chi thuOng Dien thoai - E-mail -

Nay toi dung 14 dy tuyen hyc bang Hip dinh de di hyc ThS/IS tyi nam 2020 do B0 Giao dye va Dão ta -) thong bao tuyen sin)). Tgi lam \fan ban nay, cam ket ye viec tg khi tot nghiep dyi hpc vao [hang nam den nay tOi Ainh deiu clung (x) vdo o (hail dOy có nOi dung phit hp'):

Chua di lam. Da di lam tai:

Ten cac co quan: Thai gian lam yiee: tit thang/nam den thang/nam Che dO tarn viele (gl i chi tiet eC) hoc khOng ce quyet dinh tuyen dyng, hap dOng lam vie, hop &Mg lao Ong oi died hart lam vie cm the):

Cho den dial diem T'Oi van dung, ti6p dinh tuyen dyng/ Toi di ket thac k hien nay khong cling nhu eac ngl Tin chaa cO quyet

Toi da duge (ten clurang trinh h trach nhiem, cy the

ay (danh &id chcm (x) veto O duai ddy ea nOi dung pith hap: we lam \dee tai Hai ca va hien ea rang buoe ve quyet pp dOng lam vie. lao Ong yeti ca quan nay. Ong am lam viec eho;... (ten ca guan) tcr thang/nam . ya On rang buOc ye quyet dimh tuyen dyng/hgp &mg lam viec, lao dOng ia vu, trach nhiem cAa nguai lao Ong vâi ca quan dinh tuyen dui-la/hop deng lAm viee, lao dOng vai bat ky Ca quan nao.

-o. quail)... cap hoe bOng hoc D1-1 ThS O mate ngoai theo c bang)... va hien dung eCm phai thyt hien cac rang buee nghia vv, hu sau:

Neu toi ke khai khO ig day dt:i hoac khCmg dung. ten xin hoan toan chiu nth nhiem sC bi xO 1) k luat theo ct c quy dinh hien hanh cut' Nha mite ( KM hOn tuven dung larn viec vet chdrn dirt an viec c a tai Xi co nit suit khi tot nghiep den nay vet vOn ban lien quail den hpc bong dã thew cdp di pc war ngoill fru& deiy "an gill kern theo cam Mt nay).

Tran gong de nghi B Giao dyc va Dao tao xem xet h6 scr du tuyen cOa toi.

.... nettn Nguiri cam ((et

(Kfi yc'i ghi r0 ha ten)

Mau 7

Mu Hcrp dOng cam kat tuyan dung Wit litm vic dé dkr tuyan di ciao tao ö mitt ugoai they hyc bang Hip dinh

(KErn theo Thong bao sait713-glIDDT ngay0thcing Snani 2020)

Cc QUAN CHU QUAN ONG HOA XA HQI CHO NGHIA VIET NAM Co' quan cong tnc Dc lb —Ty do — Hanh phtic

HOP DONG CAM KIT TUYEN DUNG

DOI VOL INC VIEN TUYEN DI DA0 TO TAI NUOC NGOAI

THEO HQC BONG HIEP MTh

- Can dr Thong bao se /TB-BGDDT ngay thang Om 2020 oh 139 trutng B9 Ciao dye va DOo too tuyen sinh di hoc & (lute ngoAi theo hoc bag Hiep dinh nam 2020;

- Can dr ...

Hem nay. ngay tai chang Col g9m:

BEN A: DON virrRu'ONG

Dai din Ong/BA

Chico vy:

Dit'n thoai:

Fax:

Dia chi:

vA

BEN B: ONG/BA Ott& tich: Viet Nam

S9 CMND: cap ngay tai

SO H9 chieu: cap ngay tAi

Hien nay

Ben A WI Ben B sau day duge g9i churm IA "Cac Ben",

CAc Ben ihea tin* nhat tri k9 ket Hop Citing cam ket tuyen dung nay (sau day goi tat la "Hcrp dtmo.") va cam ket thyc hien dUng nhcmg dieu khoEin sau day:

DIEU 1: TRACE!

1.1. De cir pen (DH/

ve tain viec

1.2. Th tie hien t

thong tinh t

COA BtN A

B cho Gieo dye va Deo tyo xet cap hoc bong, di dao tyo birth de -1S/TS) ô nute ngoai theo hoc bong Hip ,dinh d sau kin tot nghLep Ulu del cho Ben A.

tyen dung va b6 In cOng viec cho Ben B trong then han thong qua 06 died diem ben B dahoan thanh cac the tpc .sau khi t6tnghiep.

1.3. Qua theyi 11.n nay, neu Ben A khong ra quyet dinh tuyen dyng hoc khOng bo tri cOng viee c o Ben B (theo de nghicaa ben B) theo quy dinh thi Ben A tieing thiyi

han khOng • ua 06 thang cO trach nhiem bOi [loan cho ngan such Nha nutc toan b0 kinh phi 13; Ciao dye. va Dao to da chi cho Ben B hoe 0. nutc ngoai theo din Hien dinh.

I. I.

HIEM, NGHiA VI) CEA BEN B

quy dinh hien hanh d6i vei ding dan Viet Nam hoc tap et nu&

len che de bao eao mgay sau khi hoan thanh thu tçic nhap hoc ex nate 10 dinh ks, 06 thang/Ii‘ln vi khi ket thew theyi gian dao to tai nude hinh, ket qua hoc tap va nghien dru tren he theng co sa da lieu then hoc sinh do Be Giao dye va Dao to xay dyng va quart 19 va girl qua

ien hoac nOp trtit . ti6p cho Cyc Hyp tac qu6c te (HTQT) - Be Giao

va Co quan clyi Men ngoai giao eCia Viet Nan) tai nute sey tyi (nu Mit tai *Hieing tit so 10/2014/1-1-BGDDT ngay 11/4/2014).

hiep phai nOp bao cao tot lighiep theo Quy dinh UM me dr nguti di Sau dal hoc e'y rank ngoei, tilt) tyc gia han thai gian hoe tap & mite

tyc tip nhan luu hpc sinh ye mr6e ban hanh kern theo Th'Ong tu se (JDDT ngay 11/4/2014 dm BQ trutng Be Giao dye va Dim tyo.

MEW 2: TRACH

") .1 . Than thu cd

ngoei, Thyc ngoat, bite) c

ngoai ye tin tu quail 19 Itx dyeing buy

dye va Delo t baa cao quy

2.2. Sau khi t6t n h6c dal kik; ngoai va th0 W/20 14/TT-

2.3. 'feting theyi n tAi da - 03 tilling ke ngity het thec khea den too, Ben B phai n6p king va chap hanh sy dieu dOng. phan cling ding tae dm Ben A. Thiri ding tac tai co quan da eit di dao to gAp ha lAn theyi gian dao tao.

iem ty chi tra kinh phi dao tyo trong that gian gia han hpc tap (ney

h0 hoc being va chi phi dao tap neu khOng hoan thanh chtrong trinh do bat kha khang Mar: thien tai, chien tranh, tai nan, tit vong, b'enh

n ban, ehi dinh dung hoe eUa phia nutc ngoai,...), hoac de tot nghiep tree ve phyc Vc.1 tai CO quan dr di hoc, phyc vu thong du then gian hien hanh ye nghila vy eüa km hoc sinh nhan hoc bong cO sir dung

a nuetc. Viec boi [loan hoe bong va chi phi dao tyo dirge thcre hien hien hanh.

he) so tuyen • gian toi thieu

9.4. ChM trach n CO).

2.5. Bei !loan toa: dap to (tit i tat nang cO v nhung thong theo guy din ngfin sach N thee quy dirth

DIEU 3: DIEU KH AN THEC HIEN

Hop d6ng nay dove lam thanh 03 (ha) ban cO gia tri ,phdp nho nhau; Ben A gift 0101100 ban, Ben B 01(mOt) ban via 01, ban dinh kern h6 scr frng vien dé eV di hoc tai were ngoai theo hoc bong Hiep dinh gui den BO Giao doe va Dao tao.

Hai Ben cam ket thvc hien clang, cac dieu khoan da k2 k&t theo Hop ding nay. Moi nub chap, matt thuan phat sinh trong qua trinh thoc hien Hop dOng nay se duve dua ra co quan phap luat cO tham quyen giEii quya theo quy dinh hien hanh cita Nha woe.

BEN A

BEN B

(14 \id dOng du)

(ky va ghi rO ho ten)