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["担任人民陪审员申请表"]
[]
["申请人   姓名",null,"性   别",null,"出生年月      （     岁）",null,"相片"]
["民   族",null,"籍   贯",null,"出  生  地"]
["政   治      面   貌",null,"婚   姻      状   况",null,"健康状况"]
["专业技  术职务",null,null,"熟悉专业   有何特长"]
["学    历        学    位","全日制   教    育",null,null,"毕业院校    系及专业"]
[]
[null,"在    职      教    育",null,null,"毕业院校    系及专业"]
[]
["现工作单位              及职务"]
[]
["通讯地址、邮编          及联系电话"]
[]
[]
[]
[]
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["简"]
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[]
[]
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["历"]

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[]
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["简"]
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[]
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["历"]
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["奖  情"]
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["惩 况"]
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[null,"称  谓","姓   名","出生年月","政治面貌","工作单位及职务"]
["   主"]
["要  及"]
["家  社"]
["庭  会"]
["成  关"]
["员  系"]
[]
[]
["备注"]