ANEXA NR.

3
la Metodologie
Se certific exactitatea datelor
Director
_____________________________________________
(numele i prenumele)
DOMNULE DIRECTOR,
Subsemnatul(a) (iniiala tatlui)______________________________________________________________________________
___________________________________________________________________________________________, nscut() la data de
_________________________________,
COD NUMERIC PERSONAL:
cu domiciliul n localitatea _________________________________________________________________________________, judeul
(sectorul)
________________________,
strada____________________
nr.
____,
bloc______,
sc.____,
ap.____,
TELEFON:___________________, posesor al B.I./carte de identitate seria_______, nr.__________, eliberat() de Poliia
___________, la data de _________, v rog s-mi aprobai ncadrarea ca TITULAR ncepnd cu anul colar 2013-2014, pe postul
didactic/catedra________________________________________________________________________________________________
_____________________________________________________________________________________________________________
_____________________________________________________________________________________________________________
_____________________________________________________________________________________________________________
______________________________________________________________________________________________________ de la
(unitatea/unitile de nvmnt)_________________________________________________________________________________
____________________________________________________________________________________________________________
_____________________________________________________________________________________________________________
_____________________________________________________________________________________________________________
_____________________________________________________________________________________________________________,
localitatea ______________________________n baza notei ______________ i a rezultatului admis la proba practic/oral de (*)
_____________________________________________________________________________________________________________
_____________________________________________________________________________________________________________
_____________________________________________________________________________________________________________
__________________________________________________________, obinute la concursul de titularizare din anul 2009 sau la
concursul de titularizare din anul 2010 i/sau la concursul de titularizare din anul 2011.
Prezint urmtoarea situaie:
1) Studii finalizate cu examen de absolvire/licen/bacalaureat:
a) Univ., Institutul, Academia, I.P. 3 ani, Colegiul, c. postliceal, c. de maitri, Lic. Ped. etc._____________________________
_____________________________________________________________________________________________________________
_____________________________________________________________________________________________________________
_____________________________________________________________________________________________________________,
Facultatea_____________________________________________________________________________________________________
_________________________________________________________________________nivelul
studiilor
(medii,
postliceale,
universitare de scurt durat, ciclul I de studii universitare de licen, universitare de lung durat, ciclul II de studii universitare de
masterat)_____________________________________________________________________________________________________
_____________________________________________________________________________________________________________
___________________________________________________________________________, cu durata studiilor de _________ ani (zi
sau i.f., seral, f.f., f.r., i.d.), promoia ______ cu specializarea principal_____________________________________________
_____________________________________________________________________________________________________________
__________________________________________________________________________________________________________,
secundar ________________________________________________________________________, cu media la examenul de stat
(licen)/absolvire ________________________, media de departajare _______________________;
b) Univ., Institutul, Academia, I.P. 3 ani, Colegiul, c. postliceal, c. de maitri, Lic. Ped. etc._____________________________
_____________________________________________________________________________________________________________
_____________________________________________________________________________________________________________
____________________________________________________________________________________________________________,
Facultatea_____________________________________________________________________________________________________
_________________________________________________________________________nivelul
studiilor
(medii,
postliceale,
universitare de scurt durat, ciclul I de studii universitare de licen, universitare de lung durat, ciclul II de studii universitare de
masterat)_____________________________________________________________________________________________________
____________________________________________________________________________________________________________
_____________________________________________________________________________________________________________
________________________________________________________________________, cu durata studiilor de _________ ani (zi sau
i.f., seral, f.f., f.r., i.d.),
promoia ______ cu specializarea principal_____________________________________________
_____________________________________________________________________________________________________________
__________________________________________________________________________________________________________,
secundar _________________________________________________________, cu media la examenul de stat (licen)/absolvire
________________________, media de departajare _______________________;
c) Univ., Institutul, Academia, I.P. 3 ani, Colegiul, c. postliceal, c. de maitri, Lic. Ped. etc._____________________________
_____________________________________________________________________________________________________________

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_____________________________________________________________________________________________________________
_____________________________________________________________________________________________________________,
Facultatea_____________________________________________________________________________________________________
_________________________________________________________________________nivelul
studiilor
(medii,
postliceale,
universitare de scurt durat, ciclul I de studii universitare de licen, universitare de lung durat, ciclul II de studii universitare de
masterat)________________________________________________________________________________________________
_____________________________________________________________________________________________________________
________________________________________________________________________, cu durata studiilor de _________ ani (zi sau
i.f., seral, f.f., f.r., i.d.),
promoia ______ cu specializarea principal_____________________________________________
_____________________________________________________________________________________________________________
____________________________________________________________________________________________,
secundar
_________________________________________________________, cu media la examenul de stat (licen)/absolvire
________________________, media de departajare _______________________;
2) Dup absolvirea cu diplom a studiilor universitare de lung durat/licen/masterat am absolvit cursuri postuniversitare (studii
aprofundate, studii academice postuniversitare, studii postuniversitare de specializare, studii postuniversitare de masterat, studii
universitare de masterat), dup cum urmeaz:
a) Instituia (Univ., Institutul, Academia)________________________________________________________________________
_____________________________________________________________________________________________________________
_____________________________________________________________________________________________________________
specializarea________________________________________________________________________________________________
________________________________________________________________________________________, cu durata studiilor de
_____ ani (zi sau i.f., seral, f.f., f.r., i.d.), promoia _______, media de absolvire _______, media de departajare _____________ ;
b) Instituia ( Univ., Institutul, Academia)________________________________________________________________________
_____________________________________________________________________________________________________________
____________________________________________________________________________________________________________,
specializarea________________________________________________________________________________________________
________________________________________________________________________________________, cu durata studiilor de
_____ ani (zi sau i.f., seral, f.f., f.r., i.d.), promoia _______, media de absolvire _______, media de departajare _____________ ;
c) Instituia ( Univ., Institutul, Academia)________________________________________________________________________
__________________________________________________________________________________________________________
__________________________________________________________________________________________________________,
specializarea________________________________________________________________________________________________
________________________________________________________________________________________, cu durata studiilor de
_____ ani (zi sau i.f., seral, f.f., f.r., i.d.), promoia _______, media de absolvire _______, media de departajare _____________ ;
3) Am obinut definitivatul n anul ________, cu media ________, gradul II n anul ________, cu media ________, gradul I n anul
__________, cu media ________, doctoratul n anul _________, la specialitatea____________________________________
__________________________________________________________________________________________________________.
4) n anul colar 2012-2013 sunt ncadrat() cu contract pe perioad determinat pe postul/catedra de_____________________
_____________________________________________________________________________________________________________
_____________________________________________________________________________________________________________
de la_________________________________________________________________________________________________________
_____________________________________________________________________________________________________________
_____________________________________________________________________________________________________________.
5) La 1 septembrie 2012 am avut _________ ani ntregi __________ vechime n nvmnt.
6) Avize i atestate:

Tipul avizului de culte:______________________________________________

Tipul avizului de alternativ: _________________________________________
Tipul avizului unitii de nvmnt militar:______________________________
Atestat educaie special:

Aviz IGP / ARR:

Avizul liceului pedagogic:

7) CALIFICATIVUL obinut n anul colar 2010/2011_________________________

i n anul colar 2011/2012 _________________________;
8) Am ntrerupt activitatea n nvmnt pentru motivul _____________________________, cu (fr) acordul Inspectorului colar
____________________________________________________, prin decizia nr. ____________, conform art. ___________ din Legea
nr. 53/2003, republicat - Codul muncii.
9) Sunt/nu sunt unic ntreintor de familie. Am ______ copii n ntreinere. Soul/soia este/nu este angajat() n munc.
10) Prezint avizul medical nr. ______, din data ____________, emis de___________________________________________________
________________________________, din care rezult c sunt apt() pentru a preda n nvmnt i c ndeplinesc condiiile
prevzute la art. 234 din Legea nr. 1/2011 cu modificrile i completrile ulterioare, pentru a fi ncadrat() n nvmnt.
(*) Se completeaz numai de cadrele didactice care au susinut probe practice/orale n cadrul concursului.

RSPUND de exactitatea datelor nscrise n aceast cerere i declar c voi suporta consecinele dac am
comunicat date eronate.
Data ____________

Semntura____________

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ANEXEZ, N URMTOAREA ORDINE, actele n copie CERTIFICATE pentru conformitate cu originalul de ctre directorul
unitii unde funcionez n anul colar 2012-2013:
1) Copie de pe decizia de repartizare pe postul didactic de la unitatea/unitile de nvmnt la care funcionez ca
angajat cu contract individual de perioad determinat n anul colar 2012-2013
2) Copie de pe buletinul/carte de identitate din care s reias domiciliu
3) Acte doveditoare n situaia schimbrii numelui (dac este cazul)
4) Copii legalizate de pe actele de studii (inclusiv foaia matricol)
5) Copii de pe certificatele de grade didactice dobndite, respectiv avize i atestate
6) Adeverine privind calificativele acordate pentru anii colari 2010/2011 i 2011/2012 (conform fiei de evaluare)
7) Fia/fiele de evaluare a activitii metodice i tiinifice la nivel de coal, jude, naional, nsoit de documentele
justificative
8) Copii ale programelor colare elaborate i aprobate, ale coperilor manualelor colare, ghidurilor i crilor, ale
studiilor i articolelor publicate, documentele prin care s-au omologat materialele didactice
9) Copii ale adeverinelor/diplomelor din care reiese participarea la activiti desfurate n cadrul programelor de
reform coordonate de Ministerul Educaiei, Cercetrii, Tineretului i Sportului i/sau participarea la activiti desfurate
n cadrul programelor de formare continu
10) Adeverina de vechime n nvmnt
11) Documentele care s ateste punctajul acordat, eventual pentru criteriile social-umanitare
12) Acordul Ministerului Educaiei, Cercetrii, Tineretului i Sportului, inspectoratului colar, ntreprinderii de ntrerupere a
activitii (dac este cazul)
13) Copie de pe carnetul de munc i/sau copia filei corespunztoare din registrul general de eviden a salariailor
14) Avizul medical din care s rezulte c sunt apt() pentru a preda n nvmnt.

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