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) __________________________________
oliy, o’rta, umumiy, o’rta maxsus
to’liqsiz o’rta, boshlang’ich (necha sinf)
b) _______________________________________
oliy 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 (mutaxasisligi) 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___________________________
oilasi
_________________________________________
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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