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SESIZARE

Subsemnatul (a) ____________________________________ domiciliat (a) in


localitatea __________________________, str. _________________________
nr.____ bl. ______, sc.___, ap. ____, telefon ________________, act identitate seria
_______ nr. ___________, va aduc la cunostinta urmatoarele:
1. Lucrez
la
SC
_________________________
cu
sediul
in
____________________ str. ______________________ nr. ____ punct de
lucru
_________________________________
telefon
_________
administrator ____________________ :
contract individual de munca
nu am avut forma legala de angajare
2. In perioada de la _______________ (luna, an) pana la _____________ am
lucrat
la
_________________________________,
cu
sediul
in
____________________ str. __________________________ nr. ____ telefon
___________, administrator _______________________________ punct de
lucru _____________________in functia de ___________________________,
cu un program zilnic de ______ ore, avand (neavand) incheiat cu societatea
mai sus mentionata:
contract individual de munca
nu am avut forma legala de angajare
In perioada lucrata am primit lunar un salariu net de _________________ lei
si am semnat/nu am semnat state de plata.
3. Alte probleme pe care doresc sa le sesizez : ____________________________
__________________________________________________________________
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____________________________________________________________________
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Data ________________

Semnatura ______________