Obrazac DSI-1 REPUBLIKA HRVATSKA _______________________________________ (naziv tijela koje dostavlja prijavu)

MINISTARSTVO UPRAVE MAKSIMIRSKA 63

10000 ZAGREB

P R I J A V A ZA POLAGANJE DRAVNOG STRUNOG ISPITA

Podaci o slubeniku koji polae dravni struni ispit: 1. Ime i prezime _________________________________________________________________________________ 2. Datum, mjesto i drava roenja _________________________________________________________________________________ 3. Zavreni stupanj strune spreme i struka _________________________________________________________________________________ 4. Prebivalite i adresa stanovanja _________________________________________________________________________________ 5. Zaposlen u _________________________________________________________________________________ 6. Poslovi koje obavlja _________________________________________________________________________________ _________________________________________________________________________________ U______________________, dana__________________

Tonost podaovjerava:

M.P.

_______________________________________ _____________(potpis slubenika koji polae dravni struni ispit) ( taka unesenih u prijavu

_______________________ elnik tijela)