ANEXA NR.

3
la Metodologie
Se certific exactitatea datelor
Inspector colar pentru managementul resurselor umane
_____________________________________________
(numele i prenumele)

Viza Oficiului Juridic

_________________

DOMNULE INSPECTOR COLAR GENERAL,

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 repartizarea n vederea angajrii cu contract individual de
munc pe perioad nedeterminat ncepnd cu anul colar 2015-2016, pe postul didactic/catedra______________________
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
de la (unitatea/unitile de nvmnt)_____________________________________________________________________
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
____________________________________________________________________________________________________,
localitatea ___________________________________________________________________________________________,
n baza urmtoarelor rezultate:
- n baza notei la proba scris _________________ la disciplina____________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
i a rezultatului admis la proba practic/oral de (*)___________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
__________________________________________________________________________________________,
obinute la concursul de titularizare, sesiunea 2009.
- n baza notei la proba scris _________________ la disciplina____________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
i a rezultatului admis la proba practic/oral de (*)___________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
__________________________________________________________________________________________,
obinute la concursul de titularizare, sesiunea 2010.
- n baza notei la proba scris _________________ la disciplina____________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
i a rezultatului admis la proba practic/oral de (*)___________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
______________________________________________________________________________________________,
obinute la concursul de titularizare, sesiunea 2011.
- n baza notei la proba scris _________________ la disciplina____________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________

60

i a notei_____________________obinute la inspecia special la clas/proba practic/oral____________________

_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________,
obinute la concursul de titularizare, sesiunea 2012.
- n baza notei la proba scris _________________ la disciplina____________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
i a notei_____________________obinute la inspecia special la clas/proba practic/oral____________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________,
obinute la concursul de titularizare, sesiunea 2013;
- n baza notei la proba scris _________________ la disciplina____________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
i a notei_____________________obinute la inspecia special la clas/proba practic/oral____________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________,
obinute la concursul de titularizare, sesiunea 2014.
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 _______________________;

61

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, 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 2014-2015 sunt ncadrat() cu contract pe perioad determinat pe postul/catedra
de___________________________________________________________________________________________________
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
de la_________________________________________________________________________________________________
_____________________________________________________________________________________________________
____________________________________________________________________________________________________,
localitatea____________________________________________________________________________________________
____________________________________________________________________________________________________.
5) La 1 septembrie 2014 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:______________________________

62

Atestat educaie special:

Aviz IGP / ARR:

Avizul liceului pedagogic:

7) CALIFICATIVUL obinut n anul colar 2012/2013_________________________

i n anul colar 2013/2014 _________________________;

NOT:
a) Pentru absolvenii promoiei 2014 i debutanii aflai n primul an de activitate se ia n considerare calificativul parial din anul
colar 2014-2015.
b) Pentru absolvenii promoiei 2013 i debutanii aflai n al doilea an de activitate se iau n considerare calificativul pentru anul
colar 2013-2014 i calificativul parial din anul colar 2014-2015.
c) n cazul ntreruperii activitii la catedr, n perioada ultimilor doi ani colari, se iau n considerare calificativele pentru ultimii doi
ani colari n care cadrul didactic i-a desfurat activitatea.
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, cu modificrile i completrile ulterioare.
9) Sunt/nu sunt unic ntreintor de familie. Am ______ copii n ntreinere. Soul/soia este/nu este angajat() n munc.
10) Prezint
avizul/adeverina
medical()
nr.
__________,
din
data
________________,
emis()
de___________________________________________________________________________________, din care rezult c
sunt apt() pentru a preda n nvmnt i c ndeplinesc condiiile prevzute la art. 233 i 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____________

ANEXEZ, N URMTOAREA ORDINE, actele n copie CERTIFICATE pentru conformitate cu originalul de ctre directorul
unitii unde funcionez n anul colar 2014-2015:
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 2014-2015
2) Copie de pe buletinul/carte de identitate din care s reias domiciliul
3) Acte doveditoare n situaia schimbrii numelui (dac este cazul)
4) Copii legalizate de pe actele de studii (inclusiv foaia matricol/suplimentul la diplom)
5) Copii de pe certificatele de grade didactice dobndite, respectiv avize i atestate
6) Adeverine privind calificativele acordate pentru anii colari 2012/2013 i 2013/2014 (conform fiei de evaluare);
calificativul parial acordat pentru anul colar 2014-2015 (dac este cazul)
7) Adeverina de vechime n nvmnt
8) Acordul Ministerului Educaiei Naionale, inspectoratului colar, ntreprinderii de ntrerupere a activitii (dac este
cazul)
9) Copie de pe carnetul de munc i/sau copia filei corespunztoare din registrul general de eviden a salariailor
10) Avizul medical/adeverina medical din care s rezulte c sunt apt() pentru a preda n nvmnt.

63