Application Form

SCHOLARSHIP
( n ng Tuy n H c B ng)

Samsung Electronics Vi t Nam

L A1 KCN Yn Phong, X Yn Trung, Huy n Yn Phong, T nh B c Ninh

Tel.: 0241 369 6285

Applied-Post Information/V tr ng tuy n :

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

IssuedDate
(Ngy cp)

(S CMTND / HC)

Gender

Male

(Gii Tnh)

(n)

(nam)

Female

IssuedPlace
(Ni cp)

Hometown

Race

(Nguyn Qun)

(Dn tc)

Health Conditions:

Self-Assessment of Health
Conditions:

(Tnh trng sc khe)

Heigh
t

(T nh gi v tnh trng sc khe)

Cm

Able to work

(Chiu cao)

Weigh
t

sc khe lm vic

Kg

Unable to work
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)

(S con)

Single
Divorced
c thn

Married
lp gia nh

Ly d

Baby-Care:
12month age
(ang nui con nh)

1 2

< 12month age

Di 12 thng tui

Contact Information:

Permanent Address:

(Thng tin lin lc)

(H khu thng tr)

>

Trn 12 thng tui

Home Phone
(in thoi nh ring)

Temporary Address:

Mobile Phone:

(a ch tm tr)

(Di ng)

Email Address:
(a ch mail)

Contact person
(Ngi lin lc)

Eduction Background/ Thng tin trnh :

School History /Thng tin h c t p t c p THCS tr ln
Period
School Name
(Tn trng)

(Thi gian)

From

Main Major

To

(T)
(Thng/Nm
)

(Chuyn ngnh chnh)

(n)
(Thng/Nm)

Graduation Rank
(Xp loi tt nghip)

Ungraduated Students / Sinh vin ch a t t nghi p

Average Score of
Completed Semesters

When will you

graduate?

When will you able to

start working?

(im TB mn ca cc k hc hon thnh)

(Khi no bn tt nghip?)

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

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/Ch ng ch ho c kinh nghi m khc

Period
(Thi gian)

Fro
m
(T)

To
(Ti)

Certificate/
Experience Name
(Tn chng ch/ Kinh nghim)

Main Content

Organized by

(Ni dung chnh)

(T chc bi)

Self - Introduction/T Gi i Thi u B n Thn

Reasons For Applying To Samsung / L Do Xin H c

B ng Samsung

2012

.
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)