Subsemnatul__________________________________, lucrtor n cadrul
S.C.____________________________________, declar pe propria-mi rspundere c: 1. pentru a m deplasa de acas la serviciu utilizez urmtorul traseu: ____________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________, deplasarea efectund-o cu: mijloc de transport n comun (auto, C.F., metrou, tramvai, naval, aerian), mijloc de transport proprietate personal, mijloc de transport proprietate a firmei, pieton, __________________________ etc., timpul necesar pentru deplasare fiind de:____ zile, ____ ore, ____minute; 2. pentru a m deplasa de la serviciu acas utilizez urmtorul traseu: ____________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________, deplasarea efectund-o cu: mijloc de transport n comun (auto, C.F., metrou, tramvai, naval, aerian), mijloc de transport proprietate personal, mijloc de transport proprietate a firmei, pieton, __________________________ etc., timpul necesar pentru deplasare fiind de:____ zile, ____ ore, ____minute; 3. m angajez s anun angajatorul firmei, dendat, asupra oricrei modificri survenite asupra celor declarate la punctele 1.i 2.din prezenta declaraie.