ΤΕΧΝΙΚΟ ΕΠΙΜΕΛΗΤΗΡΙΟ ΕΛΛΑΔΑΣ
ΤΜΗΜΑ ΔΥΤΙΚΗΣ ΕΛΛΑΔΑΣ
ΑΙΤΗΣΗ ΕΚΔΗΛΩΣΗΣ ΕΝΔΙΑΦΕΡΟΝΤΟΣ ΓΙΑ ΣΤΕΛΕΧΩΣΗ ΜΟΝΙΜΩΝ ΕΠΙΤΡΟΠΩΝ ΤΟΥ ΤΕΕ/ΤΔΕ
ΕΠΩΝΥΜΟ ........................................................................................................................................................................................................................………………………………………
ΟΝΟΜΑ ...................................................................................................................................................................................................................................……………………………….
ΠΑΤΡΩΝΥΜΟ .......................................................................................................................................................................................................………………………………………………….
ΕΙΔΙΚΟΤΗΤΑ .........................................................................................................................................................................................................................……………………………………
ΔΙΕΥΘΥΝΣΗ ΑΛΛΗΛΟΓΡΑΦΙΑΣ
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ΠΟΛΥΤΕΧΝΕΙΟ .................................................................................................................................................................................................................…………………………………………
ΕΤΟΣ ΚΤΗΣΕΩΣ ΔΙΠΛ. ...........................................
ΑΔΕΙΑ ΑΣΚΗΣΗΣ ΕΠΑΓΓΕΛΜΑΤΟΣ ............................................. ……………………………………..
ΕΠΑΓΓΕΛΜΑΤΙΚΗ ΑΠΑΣΧΟΛΗΣΗ εργασιακή σχέση, εργοδοτικός φορέας κλπ)
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ΜΕΤΑΠΤΥΧΙΑΚΕΣ ΣΠΟΥΔΕΣ ΚΑΙ ΔΙΠΛΩΜΑΤΑ .............................................................................................................................……….
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ΤΟΜΕΙΣ ΕΙΔΙΚΕΥΣΗΣ ΑΠΟ ΑΣΚΗΣΗ ΕΠΑΓΓΕΛΜΑΤΟΣ (γενική εμπειρία, εξειδικ.αντικείμενο)
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Σε ποιες ΜΟΝΙΜΕΣ ΕΠΙΤΡΟΠΕΣ θα θέλατε να συμμετέχετε (κατά προτεραιότητα)
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Πάτρα ................................................................. 2002
Ο/Η αιτ.................
(υπογραφή)