Subsemnatul(a) ......................................................................nascut(a) la data de ........... cu domiciliul in judetul/sectorul ................................................................ localitatea .................................... strada ................................ nr ......... bloc ........... scara .... etaj ........... apartament .. nr.telefon fix .......... nr. telefon mobil .............................. posesor al BI(CI) ... seria ...... nr. ................. eliberat la data de ........ de catre ...................................... CNP ................................................... de profesie ...................................... angajat sau fost angajat din data de ..................... in functia de ............................ la SC .............................................................................. cu sediul in localitatea ......................... str .................................. nr ............. judetul .................. nr.telefon ........ luand la cunostinta despre faptul ca inspectorii de munca vor pastra confidentialitatea celor sesizate de mine in conformitate cu art.18, alin.1, lit.c din Legea nr.108/1999 (¤ republicata ¤) pentru infiintarea si organizarea Inspectiei Muncii, si cunoscand faptul ca falsul in declaratii este prevazut si pedepsit de art.292 Cod Penal cu inchisoare de la 3 luni la 2 ani sau cu amenda, adresez o petitie prin care sesizez urmatoarele probleme :

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Data,

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