%!TEX pdflatex

\documentclass{article}
\usepackage[margin=1.5cm]{geometry}
\usepackage{tabularray}
\usepackage{tikz}
\usepackage{pgf,pgffor}
\newcommand\bloccases[1]{%
    \raisebox{-0.75em}{\tikz \foreach \i in {1,2,...,#1} \draw[semithick] ({0.5*\i},0) rectangle++ (0.5,0.75) ;}
}
\newcommand\slashcases{%
    \raisebox{-0.75em}{\tikz \draw[semithick] (0,0) --++ (0.5,0.75) ;}
}

\begin{document}

\begin{tblr}{width=\linewidth,colspec={Q[4cm,r,m]X[l,m,]X[l,m]}}
    \textbf{Nom de famille} :& \SetCell[c=2]{l} \bloccases{25} & \\
    \textbf{Prénom(s)} :& \SetCell[c=2]{l} \bloccases{25} & \\
    \textbf{N° candidat} :& \bloccases{9} & \textbf{N° candidat} \bloccases{3} \\
    \textbf{Né(e) le :} & \bloccases{2}\,\slashcases\,\bloccases{2}\,\slashcases\,\bloccases{4} & \\
\end{tblr}

\end{document}