FORMULAR DE NSCRIERE

Autoritatea Electoral Permanent

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| Funcia public parlamentar solicitat:
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| Compartiment :
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Date personale :
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Numele:
Prenumele:
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Adresa:
Nr. de telefon:
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Data naterii:
Locul naterii:
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Starea civil:
Copii:
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Stagiul militar:
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Studii generale i de specialitate:
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Studii medii liceale sau postliceale:
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| Instituia
Perioada
Diploma obinut
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Studii superioare de scurt durat:
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| Instituia
Perioada
Diploma obinut
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Studii superioare de lung durat:
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| Instituia
Perioada
Diploma obinut
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|______________________________________________________________________________|
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|______________________________________________________________________________|
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|______________________________________________________________________________|
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Studii postuniversitare, masterat sau doctorat:
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|______________________________________________________________________________|
| Instituia
Perioada
Diploma obinut
|
|______________________________________________________________________________|
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|
|______________________________________________________________________________|
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|______________________________________________________________________________|
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|______________________________________________________________________________|
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|______________________________________________________________________________|
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|______________________________________________________________________________|
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|
|______________________________________________________________________________|
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|
|
Alte tipuri de studii:
|
|______________________________________________________________________________|
| Instituia
Perioada
Diploma obinut
|
|______________________________________________________________________________|
|
|
|______________________________________________________________________________|
|
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|______________________________________________________________________________|
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|______________________________________________________________________________|
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|______________________________________________________________________________|
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Limbi strine (slab, bine, foarte bine)*):
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|______________________________________________________________________________|
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Scris
Citit
Vorbit
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|______________________________________________________________________________|
|______________________________________________________________________________|
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*) Se va meniona i limba matern, acolo unde este cazul.
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Cunotine operare calculator:
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|______________________________________________________________________________|

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Cariera profesional:
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|______________________________________________________________________________|
| Perioada Instituia/Firma Funcia deinut
Principalele responsabiliti
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|______________________________________________________________________________|
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|______________________________________________________________________________|
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Detalii despre ultimul loc de munc (se vor meniona calificativele
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| acordate la evaluarea performanelor profesionale n ultimii 2 ani, dac
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| este cazul):
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|______________________________________________________________________________|
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Persoane de contact pentru recomandri:
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|______________________________________________________________________________|
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Numele i prenumele
Instituia
Funcia
Nr. de telefon
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|______________________________________________________________________________|
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|______________________________________________________________________________|
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|______________________________________________________________________________|
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|______________________________________________________________________________|

Declar pe propria rspundere, cunoscnd prevederile art. 292 din Codul penal cu privire la falsul
n declaraii, c datele furnizate n acest formular sunt adevrate, c ndeplinesc condiiile prevzute la art.
11 din Legea nr. 7/2006 privind Statutul funcionarului public parlamentar i nu m aflu n nici una dintre
situaiile stabilite de lege privind regimul juridic al conflictului de interese i al incompatibilitilor pentru
funcionarii publici.
Data ..........................
Semntura ........................................

FORMULAR DE NSCRIERE
Autoritatea Electoral Permanent
______________________________________________________________________________
| Postul solicitat :
|
|
|
| Compartiment :
|
|_____________________________________________________________________________________|
|
Date personale :
|
|
|
|
Numele:
Prenumele:
|
|
|
|
Adresa:
Nr. de telefon:
|
|
|
|
Data naterii:
Locul naterii:
|
|
|
|
Starea civil:
Copii:
|
|
|
|
Stagiul militar:
|
|______________________________________________________________________________|
|
|
|
|
|
Studii generale i de specialitate:
|
|
|
|
|
|
Studii medii liceale sau postliceale:
|
|______________________________________________________________________________|
| Instituia
Perioada
Diploma obinut
|
|______________________________________________________________________________|
|
|
|______________________________________________________________________________|
|
|
|______________________________________________________________________________|
|
|
|______________________________________________________________________________|
|
|
|______________________________________________________________________________|
|
|
|
Studii superioare de scurt durat:
|
|______________________________________________________________________________|
| Instituia
Perioada
Diploma obinut
|
|______________________________________________________________________________|
|
|
|______________________________________________________________________________|
|
|
|______________________________________________________________________________|
|
|
|______________________________________________________________________________|
|
|
|______________________________________________________________________________|
|
|
|
Studii superioare de lung durat:
|
|______________________________________________________________________________|
| Instituia
Perioada
Diploma obinut
|
|______________________________________________________________________________|
|
|
|______________________________________________________________________________|
|
|

|______________________________________________________________________________|
|
|
|______________________________________________________________________________|
|
|
|______________________________________________________________________________|
|
|
|______________________________________________________________________________|
|
|
|
Studii postuniversitare, masterat sau doctorat:
|
|______________________________________________________________________________|
| Instituia
Perioada
Diploma obinut
|
|______________________________________________________________________________|
|
|
|______________________________________________________________________________|
|
|
|______________________________________________________________________________|
|
|
|______________________________________________________________________________|
|
|
|______________________________________________________________________________|
|
|
|______________________________________________________________________________|
|
|
|______________________________________________________________________________|
|
|
|
Alte tipuri de studii:
|
|______________________________________________________________________________|
| Instituia
Perioada
Diploma obinut
|
|______________________________________________________________________________|
|
|
|______________________________________________________________________________|
|
|
|______________________________________________________________________________|
|
|
|______________________________________________________________________________|
|
|
|______________________________________________________________________________|
|
|
|______________________________________________________________________________|
|
|
|______________________________________________________________________________|
|
|
|
Limbi strine (slab, bine, foarte bine)*):
|
|______________________________________________________________________________|
|
Scris
Citit
Vorbit
|
|______________________________________________________________________________|
|______________________________________________________________________________|
|______________________________________________________________________________|
|______________________________________________________________________________|
|______________________________________________________________________________|
|______________________________________________________________________________|
|
*) Se va meniona i limba matern, acolo unde este cazul.
|
|______________________________________________________________________________|
Cunotine operare calculator:
|
|
|
|
|
|
|
|
|
|
|______________________________________________________________________________|

|
Cariera profesional:
|
|______________________________________________________________________________|
| Perioada Instituia/Firma Funcia deinut
Principalele responsabiliti
|
|______________________________________________________________________________|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|______________________________________________________________________________|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|______________________________________________________________________________|
|
|
|
|
|
Detalii despre ultimul loc de munc (se vor meniona calificativele
|
| acordate la evaluarea performanelor profesionale n ultimii 2 ani, dac
|
| este cazul):
|
|
|
|
|
|
|
|
|
|
|
|
|
|______________________________________________________________________________|
|
Persoane de contact pentru recomandri:
|
|______________________________________________________________________________|
|
Numele i prenumele
Instituia
Funcia
Nr. de telefon
|
|______________________________________________________________________________|
|
|
|
|
|______________________________________________________________________________|
|
|
|
|
|______________________________________________________________________________|
|
|
|
|
|______________________________________________________________________________|

Declar pe propria rspundere, cunoscnd prevederile art. 292 din Codul penal cu privire la falsul
n declaraii, c datele furnizate n acest formular sunt adevrate, c ndeplinesc condiiile prevzute la art.
11 din Legea nr. 7/2006 privind Statutul funcionarului public parlamentar i nu m aflu n nici una dintre
situaiile stabilite de lege privind regimul juridic al conflictului de interese i al incompatibilitilor pentru
funcionarii publici.
Data ..........................
Semntura ........................................

DECLARAIE PE PROPRIA RSPUNDERE

privind apartenena sau neapartenena ca agent ori colaborator al poliiei politice
comuniste

Subsemnatul/Subsemnata
........................................... ............................,
(numele i toate prenumele din actul de identitate, precum i eventualele nume anterioare)
cetean romn, fiul/fiica lui
.................................................... i al ......................................................
(numele i prenumele tatlui)
(numele i prenumele mamei)
nscut/nscut la ................................ n ..............................................................,
(ziua, luna, anul)
(locul naterii: localitatea/judeul)
domiciliat/domiciliat n ..................................................................................... ....................... ....
....................... .................. ................................................................................................................,
(domiciliul stabil din actul de identitate)
legitimat/legitimat cu ............................... .................................................................,
(felul, seria i numrul actului de identitate)
cod numeric personal .................................. .....................,
cunoscnd prevederile art.292 din Codul penal cu privire la falsul n declaraii, dup luarea
la cunotin a coninutului Legii nr. 187/1999 privind accesul la propriul dosar i
deconspirarea poliiei politice comuniste, cu modificrile i completrile ulterioare, declar
prin prezenta, pe propria rspundere, c .................................*) fost agent sau colaborator al
poliiei politice, n sensul art. 5 alin. (1) - (4) din lege.
De asemenea, am luat cunotin despre prevederile art. 3^1 alin. (6) din lege, potrivit
crora: "Persoanele care depun declaraia pe propria rspundere sunt exonerate de
obligaia asigurrii proteciei informaiilor secrete de stat sau secrete de serviciu".
.........................
(Data)

................................
(Semntur)

-----------*) Se nscrie de ctre semnatar, "nu am" sau "am", dup caz.

DECLARAIE PE PROPRIA RSPUNDERE

privind destituirea sau nedestituirea dintr-o funcie public n ultimii 7 ani

Subsemnatul/Subsemnata
........................................... .......................................................................,
(numele i toate prenumele din actul de identitate, precum i eventualele nume anterioare)
cetean romn, fiul/fiica lui
..................................................... i al .....................................................
(numele i prenumele tatlui)
(numele i prenumele mamei)
nscut/nscut la .................................... n .......................................................................,
(ziua, luna, anul)
(locul naterii: localitatea/judeul)
domiciliat/domiciliat n ................................................................................. ....................... ...,
....................... .................. .............................................................................................................,
(domiciliul stabil din actul de identitate)
legitimat/legitimat cu ............................... ..............................................................................,
(felul, seria i numrul actului de identitate)
cod numeric personal ................................... .....................,
cunoscnd prevederile art.292 din Codul penal cu privire la falsul n declaraii, declar prin
prezenta, pe propria rspundere, c ..................................*) fost destituit dintr-o funcie
public n ultimii 7 ani.

..................................
(Data)

.........................................
(Semntur)

-----------*) Se nscrie de ctre semnatar, "nu am" sau "am", dup caz.