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ANEXA NR. 3
la Metodologie
Se certific exactitatea datelor
Director
_____________________________________________
(numele i prenumele)
DOMNULE DIRECTOR,
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 ncadrarea ca TITULAR ncepnd cu anul
colar 2012-2013, pe postul didactic/catedra_______________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
__________________________________________________________________________________________
de la (unitatea/unitile de nvmnt)____________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________,
localitatea ______________________________n baza notei ______________ i a rezultatului admis la proba
practic/oral de (**)__________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________,
obinute la concursul naional din iulie 2008 sau la concursul organizat pentru ocuparea posturilor
didactice/catedrelor vacante n unitile de nvmnt preuniversitar din judeele nominalizate n H.G. nr.
1942/2004 din iunie-iulie 2008, la concursul de ocupare a posturilor didactice/catedrelor vacante/rezervate din 15
iulie 2009 i/sau la concursul din 14 iulie 2010.
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, seral, f.f).
promoia ______ cu specialitatea
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___________________________________________________________________________________
___________________________________________________________________________________________

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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, seral, f.f).
promoia ______ cu specialitatea
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,
universitare
de
lung
durat,
ciclul
II
de
studii
universitare
de
masterat)_________________________________________________________________________________
___________________________________________________________________________________________
__________________________________________________________________________________________,
cu durata studiilor de _____ ani (zi, seral, f.f).
promoia ______ cu specialitatea
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)__________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
specializarea________________________________________________________________________________
________________________________________________________________________________________, cu
durata studiilor de _____ ani, promoia _______, media de absolvire _______, media de departajare(***)
_____________ ;
b) Instituia ( Univ., Institutul, Academia)__________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
specializarea________________________________________________________________________________
________________________________________________________________________________________, cu
durata studiilor de _____ ani, promoia _______, media de absolvire _______, media de departajare(***)
_____________ ;
b) Instituia ( Univ., Institutul, Academia)__________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
specializarea________________________________________________________________________________
________________________________________________________________________________________, cu
durata studiilor de _____ ani, 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_________________________________________________________________________________
___________________________________________________________________________________________.

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4) Categorii dobndite (pentru antrenori):

anul__________categoria___________disciplina
sportiv________________________________________________;
anul__________categoria___________disciplina
sportiv________________________________________________;
anul__________categoria___________disciplina
sportiv________________________________________________;
anul__________categoria___________disciplina
sportiv________________________________________________;
anul__________categoria___________disciplina
sportiv________________________________________________;
5) n anul colar 2011-2012 sunt ncadrat() cu contract pe perioad determinat pe postul/catedra de
___________________________________________________________________________________________
_________________________________________________________________________________________
de la_______________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
6) La 1 septembrie 2011 am avut _________ ani ntregi __________ vechime n nvmnt.
7) Avize i atestate:

Tipul avizului de culte:______________________________________________

Tipul avizului de alternativ: _________________________________________
Tipul avizului unitii de nvmnt militar:______________________________
Atestat educaie special:

Aviz IGP / ARR:

Avizul liceului pedagogic:

8) CALIFICATIVUL obinut n anul colar 2009/2010_________________________

i n anul colar 2010/2011 _________________________;
NOT: a) Pentru absolvenii promoiei 2011 i debutanii n primul an de activitate se ia n considerare calificativul parial din anul colar 2011-2012.
b) Pentru absolvenii promoiei 2010 i debutanii n al doilea an de activitate se iau n considerare calificativul pentru anul colar 2010-2011 i
calificativul parial din anul colar 2011-2012.

9) 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.
10) Sunt/nu sunt unic ntreintor de familie. Am ______ copii n ntreinere. Soul/soia este/nu este angajat()
n munc.
11) Prezint avizul medical nr. ______, din data ____________, emis de_____________________
________________________________, din care rezult c sunt apt() pentru a preda n nvmnt i c
ndeplinesc condiiile prevzute la art. 234 din Legea educaiei naionale nr. 1/2011, 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 CERTIFICATE pentru conformitate cu originalul de ctre

directorul unitii unde funcionez n anul colar 2011-2012:
1) Copie de pe decizia de repartizare pe postul didactic de la unitatea de nvmnt la care
funcionez ca suplinitor n anul colar 2011-2012;
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);
5) Copii de pe certificatele de grade didactice dobndite/categorii pentru antrenori, respectiv avize
i atestate;

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6) Adeverine privind calificativele acordate pentru anii colari 2009/2010 i 2010/2011 (conform
fiei de evaluare). Adeverin privind calificativul parial acordat pentru anul colar 2011-2012 pentru
absolvenii promoiilor 2011 i 2012 i debutanii n primii doi ani de activitate.
7) Fia/fiele de evaluare a activitii metodice i tiinifice la nivel de coal, jude, naional,
nsoit de documentele justificative.
8) Copii ale programelor colare elaborate i aprobate, ale coperilor manualelor colare, ghidurilor
i crilor, ale studiilor i articolelor publicate, documentele prin care s-au omologat materialele
didactice
9) Copii ale adeverinelor/diplomelor din care reiese participarea la activiti desfurate n cadrul
programelor de reform coordonate de Ministerul Educaiei, Cercetrii, Tineretului i Sportului i/sau
participarea la activiti desfurate n cadrul programelor de formare continu
10) Adeverina de vechime n nvmnt;
11) Documentele care s ateste punctajul acordat, eventual pentru criteriile social-umanitare.
12) Acordul Ministerului Educaiei, Cercetrii, Tineretului i Sportului, inspectoratului colar,
ntreprinderii de ntrerupere a activitii (dac este cazul);
13) Copie de pe carnetul de munc i/sau copia filei corespunztoare din registrul general de
eviden a salariailor;
14) Avizul medical din care s rezulte c sunt apt() pentru a preda n nvmnt.

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