Anda di halaman 1dari 1

BIODATA PESERTA

TOT STBM
PROGRAM PAMSIMAS II - 2013

Nama

: .................................................................................. (L / P)

Tempat & tanggal Lahir

: ..................................................................... .............

Pendidikan Terakhir

(ditulis berdasarkan: tahun lulus, jurusan, fakultas, dan universitas :

..
..
Alamat Rumah (cantumkan juga Kabupaten dan Provinsi) :
..
..
..
Nomor HP / Telepon

: .............................................................................................

Email

:..

Pekerjaan

: .

Instansi/Lembaga Tempat Bekerja :

Jabatan di dalam Instansi

Pengalaman Kerja (dituliskan berdasarkan tahun hingga tahun 2013) :


-

Bidang Pemberdayaan

.............................................................................................................................................. ....
..........................................................................................................................................
..............................................................................................................................................
..............................................................................................................................................
- Bidang Non Pemberdayaan
...................................................................................................................................................
.........................................................................................................................................
...................................................................................................................................................
.........................................................................................................................................
..........................,...................... 2013

(Nama :................................................)