SESIZARE

Subsemnatul(a)______________________________________ identificat(ă) cu buletin /carte de identitate seria_____ nr.____________, CNP [__]__]__]__]__]__]__]__]__]__]__]__]__], vârsta ____ani, domiciliat(ă) în jud. _______________ loc. ___________________ str._______________________ nr. ___ bl._______ sc._______ et.____ ap._______ angajat(ă)/fost(ă) angajat(ă) în perioada _______________-______________ la S.C. ______________________________ S.R.L./S.A. cu sediul în loc. _________str.__________________ nr.____ bl._____ reprezentată prin _______________________________________; la firmă nr. de telefon_______________.

Punct de lucru :___________________________________________________________________________________________________

Puncte de reper ale situării în spațiu al sediului de firmă sau al punctului de lucru ______________________________________________________________________________________________________________________

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Număr de telefon la care pot fi contactat(ă) pentru informații suplimentare _________________________________ :

Prin prezenta vă relatez următoarele :

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Data : _____________ Semnătura :_________________