Nr.

___________ /_____________
Se certific exactitatea datelor
Preedintele comisiei de organizare i desfurare
a testrii
__________________________________________
(Numele i prenumele)

Domnule Preedinte,
(cerere de nscriere la testarea cadrelor didactice fr studii corespunztoare postului)
Subsemnatul(a) (cu iniiala tatlui)___________________________________________________________________________
________________________________________________________________________nscut() la data de (ziua, luna, anul)
___/____/_____.
COD NUMERIC PERSONAL:
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, ciclul II de studii
universitare
de
masterat,
universitare
de
lung
durat)___________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________,
cu
durata studiilor de _____ ani (zi, 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, ciclul II de studii
universitare
de
masterat,
universitare
de
lung
durat)___________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________,
cu
durata studiilor de _____ ani (zi, 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.
____________________________________________________________________________________________________
________________________________________________________________________________________________________________
_________________________________________________________________________________________,
Facultatea______________________________________________________________________________________________________
________________________________________________________________________________________________ nivelul studiilor
(medii, postliceale, universitare de scurt durat, ciclul I de studii universitare de licen, ciclul II de studii
universitare
de
masterat,
universitare
de
lung
durat)___________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________,
cu
durata studiilor de _____ ani (zi, 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 de licen a studiilor universitare de lung durat am absolvit cursuri
postuniversitare (studii aprofundate, studii academice postuniversitare, studii postuniversitare de specializare),
dup cum urmeaz:
a) Instituia ( Univ., Institutul, Academia)_____________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________,
cu
specializarea________________________________________________________________________________________
_____________________________________________________________________________________________, cu durata studiilor
de _____ ani, promoia _______, media de absolvire _______, media de departajare(*) _____________ ;
b) Instituia ( Univ., Institutul, Academia)_____________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________,
cu
specializarea________________________________________________________________________________________
_____________________________________________________________________________________________, cu durata studiilor
de _____ ani, promoia _______, media de absolvire _______, media de departajare(*) _____________ ;
c) Instituia ( Univ., Institutul, Academia)_____________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________,
cu
specializarea________________________________________________________________________________________
_____________________________________________________________________________________________, cu durata studiilor
de _____ ani, promoia _______, media de absolvire _______, media de departajare(*) _____________ ;
3) Dup absolvirea cu diplom de licen a ciclului I de studii universitare de licen am absolvit studii
postuniversitare de specializare, dup cum urmeaz:
a) Instituia ( Univ., Institutul, Academia)_____________________________________________________________________
_________________________________________________________________________________________________,
cu
specializarea _________________________, cu durata studiilor de _____ ani, promoia _______, media de absolvire
_______, media de departajare(*) _____________ ;
b) Instituia ( Univ., Institutul, Academia)_____________________________________________________________________
_________________________________________________________________________________________________,
cu
specializarea _________________________, cu durata studiilor de _____ ani, promoia _______, media de absolvire
_______, media de departajare(*) _____________ ;
c) Instituia ( Univ., Institutul, Academia)_____________________________________________________________________
_________________________________________________________________________________________________,
cu
specializarea _________________________, cu durata studiilor de _____ ani, promoia _______, media de absolvire
_______, media de departajare(*) _____________ ;
4) Legitimat() cu buletin/carte de identitate seria _____ nr._____________, eliberat() la data de
________________ de Poliia___________________________, cu domiciliul n localitatea___________________ strada
______________________, nr. ____, bl. _____, ap. _______, judeul (sectorul)___________________, telefon
_______________;
5) n anul colar anterior am avut urmtorul statut n nvmnt:
a) Suplinitor(oare) pe/la postul/catedra de ________________________________________________________________ de la
unitatea/unitile
de
nvmnt_________________________________________________________________________
___________________________________________________________________________________________________
_______________________________________________________________________________________________________localitate
a
__________________________________________________________________________________________
judeul
(sectorul)_______________________________;
b) Fr statut n nvmnt.
V rog s-mi aprobai nscrierea la testarea personalului didactic fr studii n specialitate
postului,
n
vederea
angajrii
pe
un
post
didactic/o
catedr
de
______________________________________________________
________________________________________________________________________________________________________________
__________________________________________________________________________________________
______________________________________________________________________________________________________,
pe
perioad determinat publicat/ vacant//rezervat/, n baza rezulatelor obinute la testare, urmnd a susine
urmtoarele probe practice/orale:
proba
practic
__________________________________________________________________________________________
__________________________________________________________________________________________________;
lucrarea scris la disciplina _________________________________________________________________________________
___________________________________________________________________________________________________
________________________________________________________________________________________________________________
_____________________________________________________________________________________________.
Interviu n specialitate postului didactic.
6) Menionez c am ntrerupt activitatea n nvmnt (sau n alt domeniu de activitate) pentru motivul
_____________________________________________, prin Decizia nr. __________, conform art. _______, din Legea nr.
53/2003 - Codul muncii, republicat, cu completrile ulterioare.
7) Prezint avizul medical nr. _________ / _____________ emis de ___________________ prin care rezult c sunt
apt() pentru a preda n nvmnt conform art. 234 alin. (1) din Legea educaiei naionale nr. 1/2011 cu
modificrile i completrile ulterioare i declar, pe proprie rspundere, c nu desfor activiti incompatibile cu
demnitatea funciei didactice i nu am fost ndeprtat din nvmnt pentru motive disciplinare sau printr-o
hotrre judectoreasc definitiv de condamnare penal.
Rspund de exactitatea datelor nscrise n prezenta cerere i declar c voi suporta consecinele n cazul unor
date eronate.

ANEXEZ N URMTOAREA ORDINE, n copie, urmtoarele acte doveditoare:

1) Copii de pe actele de studii, foaia matricol i certificat profesional (ultimul pentru absolvenii liceului
pedagogic);
1') Absolvenii promoiei curente vor prezenta copia legalizat a adeverinei de la instituia de
nvmnt superior/postliceal/mediu din care s rezulte c au susinut examenul de licen, media de
absolvire a facultii/colii postliceale/liceului pedagogic, specializarea dobndit, media anilor de studii
i faptul c pe parcursul efecturii studiilor s-a frecventat i promovat modulul pedagogic;
2) Copii de pe certificatele de natere i cstorie (pentru solicitanii care i-au schimbat numele);
3) Copie de pe fila din buletinul sau cartea de identitate cu domiciliul;
4) Copie de pe carnetul de munc i/sau copia filei corespunztoare din registrul general de eviden a
salariailor;
5) Avizul medical din care s rezulte ca sunt apt() pentru a preda n nvmnt;
6) Declaraie pe proprie rspundere c nu desfor activiti incompatibile cu demnitatea funciei
didactice i nu am fost ndeprtat din nvmnt pentru motive disciplinare sau printr-o hotrre
judectoreasc definitiv de condamnare penal.

SE COMPLETEAZ DUP REPARTIZAREA PE POSTURI

Subsemnatul(a) _____________________________________, obinnd media ________ la testarea personalului
didactic
fr
studii
n
specilaitatea
postului,
accept
repartizarea
ncepnd
cu
data
de
______________________________ pe/la postul/catedra obinut():

Unitatea de nvmnt
Post/catedra

Localitatea
Sectorul

Data_______________

Nr. ore

Semntura_____________

VERIFICAT,
Preedintele comisiei de organizare
i desafurare a testrii