: .................................................................................................................
NIP
: .................................................................................................................
PANGKAT/GOLONGAN : .................................................................................................................
TEMPAT TUGAS
: .................................................................................................................
ALAMAT TUGAS
: .................................................................................................................
NRG
: .................................................................................................................
NO. HP
: .................................................................................................................
No
.
Uraian
Ada
1.
2.
3.
FC SK Dirjen Pend. Islam ttg Penetapan sbg Guru Profesional dan NRG ,
dilegalisir Kasi PAIS
FC KGB dan KNP terakhir, dilegalisir Dinas terkait (bagi PNS)
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
NUPTK dan NRG (form S26c) dari aplikasi Padamunegeri atau DAPODIK
14.
15
Singaparna, ........................2015
Pemeriksa,
Ket :
SD
SMP
SMA
SMK