BIODATA

CALON PENYULUH AGAMA ISLAM NON PNS (PAI NON PNS)

KEMENTERIAN AGAMA KABUPATEN DEMAK TAHUN 2017
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NAMA LENGKAP
TEMPAT /TGL LAHIR
JENIS KELAMIN
PENDIDIKAN TERAKHIR
No KTP
ALAMAT LENGKAP

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:
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Lingkungan/Dusun ............................................
RT ................RW ...............................................
Desa/Kelurahan ................................................
Kecamatan ........................................................
Kabupaten Demak
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KAWIN/BELUM KAWIN*)

7. NO HP
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8. No Whatsapp
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9. Email
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10. STATUS PERKAWINAN
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11. PENGALAMAN ORGANISASI:
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12. MAJELIS TAKLIM BINAAN:
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Demak,

Oktober 2016

Yang bersangkutan

Pasphoto
3x4
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Catatan:

1. Nama dan identitas lainnya harus sesuai dengan Ijazah/KTP/KK/Rekening BAnk

2. Coret yang tidak perlu*)