Formulir A-F PDF
Formulir A-F PDF
LAPORAN PELAKSANAAN
KEGIATAN .....................................................................
1.
Penyuluh Pertanian
a. Nama/NIP
.................................................................................
b. Pangkat/Golongan
................................................................................
c. Jabatan
................................................................................
d. Unit Kerja
................................................................................
2.
Dasar Pelaksanaan
................................................................................
3.
Nama Kegiatan
.................................................................................
4.
Pelaksanaan Kegiatan
.................................................................................
a. Waktu Pelaksanaan :
.................................................................................
b. Tempat/Lokasi
.................................................................................
Hasil Pekerjaan
.................................................................................
5.
Mengetahui
Penyuluh Pertanian
(...................................)
(...................................)
Catatan :
Laporan hasil pekerjaan dilampirkan dengan identitas penyusunnya
103
FORMULIR B
SURAT KETERANGAN
Nama
.........................................................................................
b.
NIP
.........................................................................................
c.
Pangkat/Golongan :
.........................................................................................
d.
Jabatan
.........................................................................................
e.
Unit Kerja
.........................................................................................
(.........................................................)
104
FORMULIR C
SURAT KETERANGAN
Nama
.........................................................................................
b.
NIP
.........................................................................................
c.
Pangkat/Golongan :
.........................................................................................
d.
Jabatan
.........................................................................................
e.
Unit Kerja
.........................................................................................
(.........................................................)
*)
105
FORMULIR D
SURAT KETERANGAN
Nama
....................................................................................
b.
NIP
....................................................................................
c.
Pangkat/Golongan
....................................................................................
d.
Jabatan
....................................................................................
e.
Unit Kerja
....................................................................................
Nama
....................................................................................
b.
NIP
....................................................................................
c.
Pangkat/Golongan
....................................................................................
d.
Jabatan
....................................................................................
e.
Unit Kerja
....................................................................................
(.........................................................)
106
FORMULIR E
SURAT KETERANGAN
Nama
.........................................................................................
b.
NIP
.........................................................................................
c.
Pangkat/Golongan :
.........................................................................................
d.
Jabatan
.........................................................................................
e.
Unit Kerja
.........................................................................................
(.........................................................)
107
FORMULIR F
SURAT KETERANGAN
Kami yang bertanda tangan di bawah ini :
a.
Nama
.........................................................................................
b.
NIP
.........................................................................................
c.
Pangkat/Golongan :
.........................................................................................
d.
Jabatan
.........................................................................................
e.
Unit Kerja
.........................................................................................
Nama
.........................................................................................
b.
NIP
.........................................................................................
c.
Pangkat/Golongan :
.........................................................................................
d.
Jabatan
.........................................................................................
e.
Unit Kerja
.........................................................................................
(.........................................................)
*)
**) Untuk Karya tulis ilmiah yang disebarluaskan melalui media elektronik (Radio, TV)
form ditandatangani oleh pimpinan media elektronik
108