Nomor Peserta
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NRG
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Nama
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NUPTK
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Kabupaten/Kota
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Tempat Tugas
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Jenis Kepengawasan
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Golongan
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Gaji Pokok
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Tanggal Lahir
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NIP. ...........................................
Catatan:
Untuk memudahkan entry data ke aplikasi harap semua data diisi dengan benar