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[]
["DIRECCIÓN REGIONAL DE SALUD HUÁNUCO"]
["RED DE SALUD LEONCIO PRADO"]
["ANEXO 03 (FICHA DEL POSTULANTE)"]
[]
[]
["CARGO AL QUE POSTULA"]
["NÚMERO DE CONVOCATORIA AL QUE POSTULA "]
["Estimado postulante, complete la información solicitada,  sin modificar la configuración del formato. Lo señalado en el presente documento cuenta con el carácter de Declaración Jurada."]
[]
[]
[]
["I. DATOS PERSONALES (De acuerdo a lo  registrado en su DNI)"]
[]
["Apellido paterno",null,null,null,null,null,null,null,null,"Apellido materno",null,null,null,null,null,null,null,null,"Nombres"]
[]
["Edad",null,null,"Estado civil",null,null,"Nacionalidad",null,null,null,null,"Lugar de Nacimiento",null,null,null,null,null,null,null,null,"Fecha de Nacimiento"]
[null,null,null,null,null,null,null,null,null,null,null,"Departamento",null,null,"Provincia",null,null,null,"Distrito",null,"Dia","Mes",null,null,"Año"]
[]
["Género",null,null,"Documentos"]
["F",null,"M","DNI",null,null,null,"RUC",null,null,null,null,null,null,"N° Código CONADIS",null,null,null,null,null,"N° Carnet de Fuerza Armada"]
[]
["Domicilio Actual",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Movistar"]
["Dirección",null,null,null,null,null,null,null,null,null,"N° / LT / MZ",null,null,null,"Departamento",null,null,null,null,"Provincia",null,null,"Distrito",null,null,null,null,null,null,null,null,null,null,"Claro"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Entel"]
["TELÉFONOS / CORREO ELECTRONICO",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Bitel"]
["Teléfono fijo ",null,null,null,null,null,null,"N° Celular ",null,null,null,null,null,"Operador",null,null,"Correo electrónico personal"]
[]
[]
["II. FORMACIÓN ACADÉMICA"]
[]
["Tipo de Formación",null,null,"Especialidad",null,null,"Situación (incompleto, egresado, bachiller o titulado)",null,null,null,null,"Último ciclo de estudios concluidos (de encontrarse en curso )",null,null,"Centro de estudios",null,null,null,null,"Fecha inicio de estudios (indicar al menos mes y año)","Fecha término de estudios (indicar al menos mes y año)","Fecha de expedición de certificación (*)",null,null,"Número de Folio"]
["Universitaria"]
["Técnica superior (3 a 4 años)"]
["Secundaria"]
["Estudios de Post Grado"]
["Doctorado"]
["Maestría"]
["Segunda Especialización"]
["Información a consignar por postulantes profesionales Titulados y Colegiados",null,null,null,null,null," N° colegiatura",null,null,null,null,"Colegio Profesional",null,null,null,null,null,null,"Condicion a la Fecha (Habilitado y/o Inhabilitado)"]
[]
[]
["(*) Consignar la fecha de expedición del título, grado académico o certificado de estudios secundarios concluidos, según corresponda al nivel alcanzado y solicitado en el aviso de convocatoria. "]
[]
["Cursos y/o Programas de especialización"]
[]
["N°","Centro de estudios",null,null,null,null,null,"Tipo de capacitación",null,null,null,null,null,"Nombre de la capacitación",null,null,null,null,"Fecha de inicio \n(dd/mm/aaaa)",null,"Fecha de término\n(dd/mm/aaaa)","N° de Horas lectivas ",null,null,"Número de Folio"]
[1]
[2]
[3]
[4]
[5]
[6]
[7]
[8]
[9]
[10]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"TOTAL"]
["Nota: Cada curso de especialización a consignar debe ser concluido y contener como mínimo 12 horas de capacitación y los diplomados no menos de 90 horas (Salvo indicación distinta señalada en la convocatoria)."]
[]
[]
["III. EXPERIENCIA LABORAL ESPECÍFICA (Relacionada directamente con el puesto, considerando lo establecido en la convocatoria. De haber ocupado más de un puesto en la misma entidad, consignar cada uno de ellos)"]
["La experiencia laboral requerida en este rubro corresponde al desempeño  de funciones en puestos que tienen  similitud con la vacante en concurso. De requerirse un nivel mínimo de desempeño en un cargo, éste será indicado en el aviso de convocatoria. Es indispensable detallar las funciones específicas desarrolladas."]
[]
["N°","Nombre de la Institución",null,null,null,null,null,"Puesto/Cargo",null,null,null,null,null,"Funciones principales",null,null,null,null,"Fecha de inicio \n(dd/mm/aaaa)",null,"Fecha de término\n(dd/mm/aaaa)","Tiempo de Servicio",null,null,"Número de Folio"]
[1,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(ISERROR(CONCATENATE(DATEDIF(S66,U66,\"y\"),\" Años \",(DATEDIF(S66,U66,\"ym\")),\" Meses \",(DATEDIF(S66,U66,\"md\")),\" dias\")),\"Actualmente\",CONCATENATE(DATEDIF(S66,U66,\"y\"),\" Años \",(DATEDIF(S66,U66,\"ym\")),\" Meses \",(DATEDIF(S66,U66,\"md\")+1),\" Dias\"))","v":"0 Años 0 Meses 1 Dias"}]
[2,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(ISERROR(CONCATENATE(DATEDIF(S67,U67,\"y\"),\" Años \",(DATEDIF(S67,U67,\"ym\")),\" Meses \",(DATEDIF(S67,U67,\"md\")),\" dias\")),\"Actualmente\",CONCATENATE(DATEDIF(S67,U67,\"y\"),\" Años \",(DATEDIF(S67,U67,\"ym\")),\" Meses \",(DATEDIF(S67,U67,\"md\")+1),\" Dias\"))","v":"0 Años 0 Meses 1 Dias"}]
[3,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"0 Años 0 Meses 1 Dias"]
[4,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"0 Años 0 Meses 1 Dias"]
[5,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"0 Años 0 Meses 1 Dias"]
[6,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"0 Años 0 Meses 1 Dias"]
[7,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"0 Años 0 Meses 1 Dias"]
[8,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"0 Años 0 Meses 1 Dias"]
[9,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"0 Años 0 Meses 1 Dias"]
[10,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"0 Años 0 Meses 1 Dias"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Total"]
[]
["Experiencia Laboral no relacionada con el puesto"]
[]
["N°","Nombre de la Institución",null,null,null,null,null,"Puesto/Cargo",null,null,null,null,null,"Funciones principales",null,null,null,null,"Fecha de inicio \n(dd/mm/aaaa)",null,"Fecha de término\n(dd/mm/aaaa)","Tiempo de Servicio",null,null,"Número de Folio"]
[1,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"2019-05-01",null,"2019-07-31",{"$f":"IF(ISERROR(CONCATENATE(DATEDIF(S81,U81,\"y\"),\" Años \",(DATEDIF(S81,U81,\"ym\")),\" Meses \",(DATEDIF(S81,U81,\"md\")),\" dias\")),\"Actualmente\",CONCATENATE(DATEDIF(S81,U81,\"y\"),\" Años \",(DATEDIF(S81,U81,\"ym\")),\" Meses \",(DATEDIF(S81,U81,\"md\")+1),\" Dias\"))","v":"0 Años 2 Meses 31 Dias"}]
[2,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(ISERROR(CONCATENATE(DATEDIF(S82,U82,\"y\"),\" Años \",(DATEDIF(S82,U82,\"ym\")),\" Meses \",(DATEDIF(S82,U82,\"md\")),\" dias\")),\"Actualmente\",CONCATENATE(DATEDIF(S82,U82,\"y\"),\" Años \",(DATEDIF(S82,U82,\"ym\")),\" Meses \",(DATEDIF(S82,U82,\"md\")+1),\" Dias\"))","v":"0 Años 0 Meses 1 Dias"}]
[3,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"0 Años 0 Meses 1 Dias"]
[4,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"0 Años 0 Meses 1 Dias"]
[5,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"0 Años 0 Meses 1 Dias"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Total"]
[]
["IV. INFORMACIÓN COMPLEMENTARIA"]
[]
["¿Declara su voluntad de postular en ésta convocatoria de manera transparente y de acuerdo a las condiciones señaladas por la Institución?"]
[]
[null,null,null,null,null,null,"SI","(",")",null,null,null,null,null,null,null,null,null,"NO","(     )"]
[]
["¿Tiene familiares directos* dentro del Cuarto Grado de Consanguinidad, Segundo de Afinidad o por razón de matrimonio, trabajando en la RED DE SALUD Leoncio Prado?"]
[]
[null,null,"SI","(",")","Señale nombre y parentesco:_______________________________________________",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"NO","(     )"]
[]
["En aplicación a lo establecido por el artículo 48º de la Ley Nº 29973, Ley General de Personas con Discapacidad, responder si ¿Tiene algún tipo de discapacidad?:"]
[]
[null,null,null,null,null,null,"SI","(",")",null,null,null,null,null,null,null,null,null,"NO","(     )"]
["(*) De ser positiva su respuesta, señale el tipo de discapacidad y registre el número de folio:"]
["Tipo :",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Folio :"]
[]
["¿Se encuentra usted comprendido dentro del registro de deudores alimentarios morosos, de acuerdo a la Ley N° 28970?"]
[]
[null,null,null,null,null,null,"SI","(",")",null,null,null,null,null,null,null,null,null,"NO","(     )"]
[]
["Indique si es Licenciado de las Fuerzas Armadas."]
[]
[null,null,null,null,null,null,"SI","(",")",null,null,null,null,null,null,null,null,null,"NO","(     )"]
[]
["(*) De ser positiva su respuesta, señale el número de folio:"]
[]
[]
["Fecha de presentación:",null,null,null,null,null,"Fecha",null,null,null,null,null,null,null,null,"Firma"]
[null,null,null,null,null,null,"Día",null,"Mes",null,"Año"]

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