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["惠州市工业和信息化局专家入库申报表"]
[]
["推荐单位：                                          ",{"$nulls":3},"      填表人："]
["姓    名",null,"性    别",null,null,"相片（不限底色，可电子 版打印）"]
["出生年月",null,"籍    贯"]
["政治面貌",null,"学    历"]
["身份证号",null,"学    位"]
["职    称",null,"职    务"]
["任职单位"]
["联系地址",null,"邮政编码"]
["单位电话",null,"家庭电话"]
["手    机",null,"传    真"]
["电子信箱"]
["专业领域"]
["主要简历"]
[" 主要成就"]
["承担社会工作情况"]
["推荐单位\n意见"]
[null,"                 （盖章）               "]
[null,"                                                   年      月     日"]
["本人意见","    本人对所填表格内容和提供证明材料真实性负责，郑重承诺所提交的相关材料是真实原件的复印件，不存在虚假行为，在过往从业中无不良记录。本人愿意担任该专家库人选，认真履行相应职责。"]
[null,"                         签名：                   年      月     日"]