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Format Biodata Sertifikasi Guru

Format Biodata Sertifikasi Guru

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Published by: adhyatnika geusan ulun on Dec 10, 2009
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04/12/2013

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BIODATA PESERTA SERTIFIKASI GURU TAHUN 2009

KELURAHAN/KECAMATAN : ………………………………………………………………………………………………………
KABUPATEN/KOTA : ………………………………………………………………………………………………………
PROPINSI : ………………………………………………………………………………………………………
NOMOR PESERTA : ………………………………………………………………………………………………………
1. IDENTITAS
a. INSTANSI/NAMA SEKOLAH
b. NAMA LENGKAP
c. NIP/NIK
. GELAR AKADEMIK
!. TEMPAT LAHIR
". TGL#LAHIR / /
$. %ENIS KELAMIN 1. La&'(La&' 2. P!)!*+,a-
.. AGAMA 1. I/0a* 2. P)12!/2a- 3. Ka2.10'& 4. H'-, 5. B,.a 6. K.1-$ H, C.,
'. STATUS KA7IN 1. Ka8'- 2. B!0,* Ka8'- 3. D,a/%a-a
9. STATUS KEPEGA7AIAN 1. PNS : a. P!-''&
b. T!-a$a K!+!-''&a-
2. N1- PNS : a. G,), T!2a+ !. G,), H1-1) Da!)a.
b. G,), T'a& T!2a+ ". G,), S,&a)!0a8a-
c. G,), Ba-2, $. La'--:a ……………
. G,), ;a:a/a-
&. PANGKAT/GOLONGAN 1. I/a 2. I/b 3. I/c 4. I/ 5. II/a 6. II/b
<K.,/,/ PNS= >. II/c ?. II/ 9. III/a 10. III/b 11. III/c 12. III/
13. I@/a 14. I@/b 15. I@/c 16 I@/ 1>. I@/! 1?. 0a'--:a ……
0. TMT PNS / /
*. TMT#TUGAS / /
-. NO KTP
1. ALAMAT#RUMAH
<S!/,a' KTP= RT R7
KELURAHAN
KECAMATAN
KABUPATEN/KOTA
PROPINSI
KODE POS
+. TELEPON RUMAH (
A. NO HP
2. SUAMI/ISTRI
a. Na*a S,a*'/I/2)' :
b. P!&!)9aa- 1. PNS 2. N1- PNS
c. NIP
<a+ab'0a /,a*'/'/2)' /!ba$a' PNS=
3. ANAK
a. %,*0a. A-a&
Na*a S2a2,/ A-a& T!*+a2 La.') Ta-$$a0 La.') Ta.,- Ma/,&
b. Na*a O)a-$2,a <Ib, Ka-,-$= :
4. BEASIS7A
N1. %!-'/ P!-:!0!-$$a)a S,*b!) Da-a
Ta.,- Ma/,&
a8a0 a&.')
5. INFORMASI STUDI BANDING
N1. %!-'/ S2,' Ba-'-$ P!-:!0!-$$a)a Ta.,- S,*b!) Da-a T,9,a- <T!*+a2=
6. HASIL NILAI U%IAN DAN UAN ;ANG DIA%ARKAN
N1. Ma2a P!0a9a)a- N'0a' T!)2'-$$' N'0a' T!)!-a. Ta.,- %,*0a. S'/8a
>. INFORMASI TUN%ANGAN
N1. %!-'/ T,-9a-$a- Ta.,- M!-!)'*a I-/2a-/' :a-$ M!*b!)' S,*b!) Da-a
?. LAIN ( LAIN
………………………………………………………………………………………………………………………………………………………….
………………………………………………………………………………………………………………………………………………………….
………………………………………………………………………………………………………………………………………………………….
………………………………………………………………………………………………………………………………………………………….
………………………………………………………………………………………………………………………………………………………….
………………………………………………………………………………………………………………………………………………………….
………………………………………………………………………………………………………………………………………………………….
M!-$!2a.,' : P!/!)2a
K!+a0a S!&10a. :
………………………………… 2009
…………………………………………..
Kab/K12a ……………………………….
%!-9a-$
S!&10a.
…………………………………………… …………………………………………

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