Chestionar

1. Numele şi prenumele_______________________________________________________________
2. Data şi locul naşterii________________________________________________________________
3. Date de identificare (buletin / certificat de naştere) Seria_________Nr.________________________
IDPN________________________________eliberat de ___________________________________
4. Naţionalitatea_____________________________________________________________________
5. Domiciliul________________________________________________________________________
6. Date de contact: tel fix:___________________________mobil______________________________
Email:___________________________________________________________________________
7. Starea familială (căsătorit, necăsătorit, divorţat ect.)_______________________________________
8. Copii____________________________________________________________________________
9. Tipul de familie(familie completă, monoparentală, orfan)____________________________________
________________________________________________________________________________
10. Studiile__________________________________________________________________________
11. Specialitatea______________________________________________________________________
12. Instituţia de învăţământ (finisată)______________________________________________________
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13. Experienţa profesională_____________________________________________________________
________________________________________________________________________________
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14. Starea sănătăţii___________________________________________________________________
15. Frecventezi care-va cercuri, sau nu?___________________________________________________
________________________________________________________________________________
16. Cum îţi petreci timpul liber___________________________________________________________
________________________________________________________________________________
17. Alte date despre tine care crezi că sunt relevante________________________________________
________________________________________________________________________________
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Data:__________________________________________________________________________________

Semnătura: ____________________________________________________________________________