Application Form

n Xin Vic
(Staff Nhn Vin)

Samsung Electronics Vit Nam

L A1 KCN Yn Phong, X Yn Trung, Huyn Yn Phong, Tnh Bc Ninh
Tel.: 0241 369 6285
; 0241 369 6048

Applied-Post Information/V tr ng tuyn:

Job Title

Expected-work field

(V tr ng tuyn)

(Lnh vc cng vic mong mun)

Personal Information/ Thng tin c nhn:

Photo
(4x6)

Full Name

Birthday

(H v tn)

(Ngy thng nm sinh)

ID /Passport No

Issued-Date

(S CMTND / HC)

(Ngy cp)

Male

Gender
(Gii Tnh)

(nam)

Female

(n)

Issued-Place
(Ni cp)

Hometown

Race

(Nguyn Qun)

(Dn tc)

Health Conditions:

Self-Assessment of Health Conditions:

(Tnh trng sc khe)

(T nh gi v tnh trng sc khe)

Height

Cm

Able to work

(Chiu cao)

Weight

Unable to work

sc khe lm vic

Kg

Cha sc khe lm vic

(Cn nng)

Clear notice about your chronic disease or other attention, if any:

(Xin ghi r bnh mn tnh hoc cc lu khc v sc khe, nu c):

Marriage Status:

Number of children:

(Tnh trng hn nhn)

Single

Married

c thn

1 2

(S con)

lp gia nh

Divorced
Ly d

Baby-Care:

< 12month age

(ang nui con nh)

Contact Information:

Permanent Address:

(Thng tin lin lc)

(H khu thng tr)

Di 12 thng tui

> 12month age

Trn 12 thng tui

Home Phone
(in thoi nh ring)

Mobile Phone:
(Di ng)

Email Address:

Temporary Address:
(a ch tm tr)

(a ch mail)

Contact person
(Ngi lin lc)

Eduction Background/ Thng tin trnh :

School History /Thng tin hc tp t cp THCS tr ln
Period
School Name
(Tn trng)

(Thi gian)

From

To

(T)
(Thng/Nm
)

(n)
(Thng/Nm)

Main Major
(Chuyn ngnh chnh)

Graduation Rank
(Xp loi tt nghip)

Ungraduated Students / Sinh vin cha tt nghip

Average Score of Completed
Semesters

When will you graduate?

When will you able to start working?

(Khi no bn tt nghip?)

(Khi no bn c th bt u i lm?)

(im TB mn ca cc k hc hon thnh)

Languages/Ngn ng
Languages
(Ngn ng)

Self-Evaluation
(T nh gi)

Good

Avg.

Poor

Tt

Trung bnh

Km

Rank / Score Evaluated

By Education Organization
(Hng/im do t chc gio dc nh gi)

ENGLISH
KOREAN
JAPANESE
CHINESES
VIETNAMESE

Other Certificate or Experience/Chng ch hoc kinh nghim

khc
Period
(Thi gian)

From

To

(T)

(Ti)

Certificate/ Experience Name

Main Content

Organized by

(Tn chng ch/ Kinh nghim)

(Ni dung chnh)

(T chc bi)

Self - Introduction/T Gii Thiu Bn Thn

Reasons For Applying To Samsung / L Do D

Tuyn

Vo Samsung

.
4

.
I hereby declare that the information given by me in this form is correct and true to the best of my knowledge. I
truly understand and accept any disciplinary measure if the false declaration. (Ti xin xc nhn thng tin nu
trn y l hon ton xc thc. Ti xin hon ton chu trch nhim v k lut lao ng nu khai bo sai)

Date (Ngy):

Applicants

Signature & name (K v ghi r tn)