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IOAN-MIHAI GALE
Subsemnatul/a_________________________________________________________,
IV
medic rezident anul______, LOC incadrat/a la ____________________________
loc/post______ SPITALUL CLINIC MUNICIPAL CLUJ
1390 08.12.2016
confirmat/a prin ordinul MS nr.___________/________________,
CHIRURGIE GENERALA
specialitatea____________________________________________________, cu pregatire in
CLUJ-NAPOCA
centrul universitar __________________cu MUN. ARAD
domiciliul in localitatea___________________,
VASLUI
str______________________, 7
nr._____, bl._____, B 8
723 sc.____ap.______,
ARAD
judet/sector______________________, 0752387920
telefon____________________,
Prin prezenta solicit:
PRELUNGIREA PREGATIRII IN REZIDENTIAT CU UN AN, AVAND IN VEDERE INTRERUPEREA
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PREGATIRII IN PERIOADA 01.08.2020 PANA LA 01.08.2021 CONFORM ADEVERINTEI ANEXATE
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IOAN-MIHAI GALE
Subsemnatul ________________________________________________ declar că am
luat la cunoștință drepturile mele conform legislației în materie de prelucrare de date cu
caracter personal, în conformitate cu Regulamentul UE nr. 679/2016 și îmi exprim
consimțământul pentru prelucrarea datelor cu caracter personal.
DA sunt de accord NU sunt de accord

Cu multumiri

Data Semnatura
28.06.2021 Dr. Ioan-Mihai Gale