1. Hoï vaø teân: Full nam: 2. Giôùi tính: Sex: 3. Ngaøy, thaùng, naêm sinh: Date of birth: 4. Tình traïng hoân nhaân: Marital status: 5. Quoác tòch goác: Nationality of origin: 6. Quoác tòch hieän taïi: Present nationality: 7. Ngheà nghieäp hieän taïi: Present profession: 8. Nôi laøm vieäc cuoái cuøng hoaëc hieän taïi: Last or present work place: II – QUAÙ TRÌNH ÑAØO TAÏO: Training Background ........................................................................................................................................ ........................................................................................................................................ ........................................................................................................................................ ........................................................................................................................................ III – QUAÙ TRÌNH LAØM VIEÄC CUÛA BAÛN THAÂN (KEÅ CAÛ ÔÛ VIEÄT NAM): Employment Records 9. Ñaõ laøm vieäc ôû nöôùc ngoaøi: Employment outside Vietnam .................................................................................................................................... .................................................................................................................................... .................................................................................................................................... 10. Ñaõ laøm vieäc ôû Vieät Nam: Employment in Vietnam .................................................................................................................................... .................................................................................................................................... .................................................................................................................................... IV – LYÙ LICH VEÀ TÖ PHAÙP: Legal Status 11. Ñaõ vi phaïm phaùp luaät vieät Nam laàn naøo chöa? Have you ever violated the Vietnamese law? .................................................................................................................................... .................................................................................................................................... 12. Ñaõ vi phaïm phaùp luaät nöôùc ngoaøi laàn naøo chöa? Möùc ñoä vi phaïm? Have you ever violated law of any other country? Level of violation? .................................................................................................................................... .................................................................................................................................... 13. Toâi xin cam ñoan lôøi khai treân laø ñuùng söï thaõt, neáu sai toâi xin chòu traùch nhieäm. I certify that these statements are true to the best of my knowledge and will be responsible for their correctness. Ngaøy....thaùng.....naêm............. Date, ............................................ Ngöôøi khai kyù teân (Signature)