河南2012卫生高级专业技术职务业务水平考试报名汇总表
| 填报单位（盖章）： |
级别： |
填报时间： |
| 序号 |
姓名 |
性别 |
出生年月 |
身份证号 |
学历 |
毕业时间 |
毕业学校及专业 |
工作单位 |
现任专业技术职务 |
聘任时间 |
现从事专业 |
执业医师类别 |
申报专业 |
报考专业 |
备注 |
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说明：1、所有栏目必须如实填写，漏填项目不受理报名；2、正、副高分别填写；3、按报考专业依次填写，考试报名表按顺序排放；4、表中涉及的时间只填数字不填汉字，例：出生年月填写“68.06”，学制填“5”；5、以省辖市为单位，省直按单位填写。6、此表用A3纸打印。
