CTRE,

CENTRUL DE RESURSE UMANE N SNTATE PUBLIC

Doamnei director Gabriela ANGHELOIU

Subsemnatul/a ___________________________________________________________,
nume purtat anterior_______________________ fiul/fiica lui ___________i_______________,
nascut/ n localitatea________________ judeul_______________la data de _____________,
cu domiciliul n localitatea________________, str____________________________, nr._____,
bl._____, sc.____ap.______, jude/sector_________________, telefon____________________,
mail______________________________________, avnd CNP_________________________,
legitimat / cu Carte de identitate seria_____ nr.___________eliberat de ctre______________,
la data de____________ absolvent/ al/a_____________________________________________
_____________________________________________________________________________
n anul ________________titular/ al/a diplomei de licen seria_____nr.__________________
i al certificatului de medic/medic dentist/farmacist specialist seria_____ nr.___________ din
data _____________, specialitatea _________________________________________________.
Prin ___________________________________, mputernicit n baza procurii speciale
nr.__________ din data de___________________,
Prin prezenta v rog s mi eliberai Documentul care atest formarea n profesia de
_____________________________________________________________________conform
DC 2005/36/CE i/sau asimilarea denumirilor titlurilor de calificare cu cel prevzut pentru
Romnia de aceast norm conform documentelor depuse.
Menionez c am depus urmtoarele documente justificative:
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Data Semntura
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