TRNG I HC SI GN

KHOA..

CNG HA X HI CH NGHA VIT NAM c lp T do Hnh phc

NN XXIINN II HHCC

Knh gi: - Hiu trng trng i hc Si Gn;

- Trng phng T chc Cn b.

- Trng khoa, n v..

Ti tn l: ................................................................................ Nam/N: ............

Sinh ngy ........ thng ....... nm ......... Ni sinh: ..................................................

in thoi lin lc:....................................................

Ti tham gia cng tc ti Trng i hc Si Gn t ngy......... / .... / .........

Cng vic m nhim: ........................................................................................

Nay ti lm n ny xin c i hc tp nng cao trnh ti trng .............

(c giy bo nhp hc km theo).

Thi gian hc......nm.

Chuyn ngnh :. ..............

Nu c chp nhn, ti cam kt thc hin tt cc cng vic c giao v hon

thnh hc kha hc theo ng thi gian quy nh.

kin ca Trng n v

Tp.H Ch Minh, ngy .. thng nm ...

Ngi lm n

kin ca Trng phng TCCB

Duyt ca Hiu trng Ngy ....../ .... / ........