Dragos COMAN

COALA DE MESERII CONCORDIA

FORMULAR DE NSCRIERE/PRENSCRIERE

I. Date de identificare ale candidatului:

1. Nume i prenume (cu majuscule):_______________________________________________________

2. Sex: feminin ________________ masculin ______________________________________________

3. Naionalitate/Etnie: _________________________________________________________________

4. Religie: ___________________________________________________________________________

5. Data naterii: __________________

6. Serie i nr. buletin (carte de identitate): _________________________________________________

7. Cod numeric personal: _______________________________________________________________

8. Domiciliu stabil: ____________________________________________________________________

9. Domiciliul prinilor: _________________________________________________________________

10. Telefonul unde poate fi contactat de urgen: _____________________________________________

11. Adres e-mail: ______________________________________________________________________

II. Informaii colare relevante despre candidat:

(Completai cmpurile care reprezint cel mai bine situaia n care v aflai)

1. Ultima coal absolvit: ___________________________________________________________

2. Media colii absolvite (n cifre i n litere): _____________________________________________

3. Sunt elev la _____________________________, anul de studiu ____________________________

4. Am fost elev, dar am ntrerupt studiile la coala/ Liceul __________________________________n perioada ______________________ pentru motivul____________________________________

5. Am absolvit specializarea __________________, la ________________________ fiind susinut de ctre____________________________________________________________________________

III. Opiunea candidatului

Buctar

Osptar

Brutar

Tmplar/Dulgher/Parchetar

Agricultor/Horticultor

IV. Activiti extracuriculare/Expriena n munc:

____________________________________________________________________________________

____________________________________________________________________________________

V. Situaie medical. V rugm s precizai starea general de sntate n ultimii doi ani:

Foarte bun

Bun, detaliai dac este cazul: ___________________________________________________

Proast detaliai: ______________________________________________________________

Intervenii spitaliceti- detaliai: ___________________________________________________

VI. Subsemnatul ________________________________, declar pe proprie rspundere, cunoscnd consecinele juridice ale declaraiilor nesincere, prevzute de art. 292 Cod Penal, c informaiile oferite sunt corecte i reale. Am luat la cunotin c, n eventualitatea c voi fi declarat admis, dobndirea calitii efective de elev se face doar dup prezentarea actelor n original la sediul colii, n termenul stabilit.Data,

Semntura,

_________________

____________________________

C E R E R E

Subsemnatul(a) __________________________________________________,

absolvent() al(a) colii _______________________, din Localitatea _____________________, Judeul

________________,

V rog s-mi aprobai nscrierea n cadrul colii de Meserii CONCORDIA, specializarea

________________, pentru anul colar 20___-20___.

V mulumesc anticipat,

Nume, prenume:

Semntura:

DATA: