TRNG TRUNG CP PHNG CNG HA X HI CH NGHA VIT NAM

NAM
c lp T do Hnh phc

PHIU NG K TUYN SINH (KTS)

TRUNG CP CHUYN NGHIP NM 2017

1. S phiu: (th sinh khng ghi mc ny)

2. Hnh thc tuyn sinh: Xet tuyn
0
3. Tn trng ng k tuyn sinh :
TRNG TRUNG CP PHNG NAM 0 2 1 8
4. Ngnh d tuyn: (ghi bng ch vo ng k chm) M trng

.................................................................................................................................................
5. H v tn ca th sinh: (vit ch in hoa)
.............................................................................Gii tnh: (N ghi 1, Nam ghi 0)
6. Ngy, thng v hai s cui ca nm sinh:
(Nu ngy, thng nh hn s 10 ghi s 0 u). Ngy thng nm
7. Ni sinh (ghi tn tnh):................................................................Dn tc:................................
8. H khu thng tr: ghi r s nh, ng ph, thn, x (phng), huyn (qun), tnh
(thnh ph)...........................................................................................................................
.................................................................................................................................................
9. Ni tt nghip THCS, THPT: (ghi r tn trng v a ch ni trng ng: x (phng),
huyn (qun), tnh (thnh ph) vo ng k chm v ghi m tnh ni trng ng, m
trng vo ).
.................................................................................................
M tnh M trng
.................................................................................................
10. Ni np h s KTS: ............................................................................................................
11. Tt nghip cp no th khoanh trn vo cp : (THCS, THPT). Ghi nm tt nghip
THCS, THPT vo : (ghi 4 s ca nm tt nghip).
12. Hc sinh rt tt nghip THPT ho c hc d dang THPT: (ghi r lp ang hoc d
dang)....................................................................................................................................
13. Khi cn bo tin cho ai, theo a ch no: (ghi r tn, s nh, ng ph, thn, x
(phng), huyn (qun), tnh (thnh
ph) : ....................................................................................... ..............................................
..................................................................................................
in thoi (nu c).................................................................................................................
Ngy thng nm 2017
CH K TH SINH