CERERE

Catre

Subsemnatul/a_________________________________________________________,
medic rezident anul______, loc/post______ incadrat/a la ____________________________
confirmat/a prin ordinul MS nr.___________/________________,
specialitatea____________________________________________________, cu pregatire in
centrul universitar __________________cu domiciliul in localitatea___________________,
str______________________, nr._____, bl.____, sc.___ap.___, judet__________________,
telefon____________________,adresa mail_____________________________________

Prin prezenta va rog sa-mi aprobati intreruperea rezidentiatului in perioada de la

______________ si pana la ________________ si suspendarea drepturilor salariale,
pentru :
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
___________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________

Anexez:
-copie carte identitate
-copie prima fila carnet rezident
-copie acordul coordonatorului de rezidentiat
-adeverinta de la spitalul platitor din care reiasa ca s-a aprobat concediu fara plata.

Cu multumiri

Data Semnatura