1. Familiyasi______________________________
ismi___________otasining ismi_____________
2. Tug’ilgan yili_______kuni______oyi_________
3. Tug’ilgan joyi___________________________
_________________________________________
_________________________________________
4. Millati_________________________________
5. Partiyaviyligi____________________________
a’zo bo’lgan yili
6. Ma’lumoti
a) __________________________________
oily, o’rta, umumiy, o’rta maxsus
to’liqsiz o’rta, boshlang’ich (necha sinf)
b) __________________________________
oily yoki maxsus o’rta o’quv
_________________________________________
muassasaning nomi va
_________________________________________
tugallagan yili
d) __________________________________
bilim yurti, hunar-texnika
_________________________________________
maktabning nomi
_________________________________________
va tugallagan yili
e) O’qish usuli kunduzgi, kechki, sirtqi_____
_________________________________________
(nokeragi o’chirilsin)
7. Diplom bo’yicha mutaxassisligi (shahodatnoma)
_________________________________________
oily yoki maxsus
_________________________________________
o’rta o’quv muassasasini tugallaganlar uchun
8. Diplom (shahodatnoma)ga ko’ra ixtisosligi
_________________________________________
Diplom (shahodatnoma) №________20____y.
“_______” da berilgan
To’ldirilgan vaqti 20____y. “_________”
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9. ____________________________________
asosiy (mutaxassisligi) kasbi
______________________________________
______________________________________
shu kasbi bo’yicha ish staji
10. Umumiy ish staji_____________________
11. Uzluksiz ish staji_____________________
12. ___________________________________
oxirgi ish joyi, mansabi
______________________________________
ishdan bo’shash sababi va vaqti
13. Oilaviy ahvoli_______________________
______________________________________
har bir oila a’zosining tug’ilgan
______________________________________
yili kursatilsin
14. ___________________________________
15. 16.___________________________________
17. ___________________________________
18. Pasporti: seriyasi______№______________
Kim tomonidan berilgan________________
_______________________________________
Berilgan vaqti________________________
19. Uy manzili___________________________
______________________________________
Telefoni_____________________________
Imzosi _____________________________
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