Fillable Fiche de renseignements sur le candidat (Ceci nest

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Fiche de renseignements sur le candidat (Ceci nest

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Fiche de renseignements sur le candidat
(Ceci n’est pas un dossier d’inscription)
A remplir par le candidat et sa famille
Nom : …………………………………………………………..……..………………… Prénom : ……………………………………...……………..………………………………
Date de naissance : ………………………………………………………………………………………………………………………………………………………………………………………
Candidature en classe de :
U.L.I.S 4
ème
Prépa-métiers à coloration numérique 3
ème
Prépa-métiers à coloration numérique
CAP Maintenance des Bâtiments de Collectivités (MBC) ○ 1
ère
Année ○ 2
ème
Année
CAP Menuisier Fabricant (MF) ○ 1
ère
Année ○ 2
ème
Année
CAP Électricien(ne) ○ 1
ère
Année ○ 2
ème
Année
BAC Prof. Assistance à la Gestion des Organisations et de leurs Activités (AGOrA) (anciennement Gestion Administration)
Coloration Comptabilité Coloration Audiovisuelle, gestion de production ○ 2
nd
○ 1
ère
○ Term
BAC Prof. Technicien Menuisier Agenceur (TMA) ○ 2
nd
○ 1
ère
○ Term
BAC Prof. Métiers de l’électricité et des systèmes numériques (MESN) ○ 2
nd
BAC Prof. Systèmes Numériques (SN) Option A: SSIHT Option B: ARED Option C: RISC ○ 1
ère
○ Term
BAC Prof. Métiers de l’ELectricité et de ses Environnements Connectés (MELEC) ○ 1
ère
○ Term
Nom des parents ou des responsables légaux :
M. et Mme M. Mme ……………........................................................................................................................................................
Mail : ……………………………………………………………………....................................
portable : ………………………………………………………………….
Comment avez-vous connu notre établissement :
Site internet du lycée C.I.O. ou C.I.D.J.
Etablissement actuel Brochure spécialisée
Autre (préciser) …………………………………………………………………………………………..…………………………………………………………………………………..
Année Classe Etablissements fréquentés
2020/2021
Privé sous contrat Privé hors contrat Public Internat
Nom : ………………………………………………………………………………………………………………………………
Code postal : ……………………………………. Ville : ……………………………………………………………..
A remplir par l’établissement
Visite des ateliers le : ………………………………………..………………………………………………………………………………………………… à …………….. h ………….
Entretien avec : …………………………………………….………………………………. le :………………………………………………………………. à …………….. h …………
Projet Personnel et Professionnel (Profession souhaitée, études envisagées, motivation…) :
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Scolarité (Redoublement, changement d’établissement, niveau…) :
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Remarques particulières (Problème de santé, dyslexie, PPS…) :
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Observations :
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Réponse
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en attente du 2
ème
Trimestre en attente du 3
ème
Trimestre Non
Date de remise de dossier : ………………………………………………………………………………………………………………………………………………………………...
Complet Incomplet
Manque :
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Fiche de renseignements sur le candidat (Ceci nest

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Completed 20 January 2021

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