Formulir PTK Baru

Identitas
Nama Lengkap : ..................................................................................................................
Jenis Kelamin : ..................................................................................................................
Tempat, Tanggal Lahir : ..................................................................................................................
NIK : ..................................................................................................................
NUPTK : ..................................................................................................................
pastikan NUPTK valid, karena setelah disimpan tidak dapat diperbaiki
dari aplikasi dapodik
Agama : ..................................................................................................................
Nama Ibu Kandung : ..................................................................................................................
Status Perkawinan : ..................................................................................................................
No HP : ..................................................................................................................

Domisili
Propinsi : ..................................................................................................................
Kabupaten/Kota : ..................................................................................................................
Kecamatan : ..................................................................................................................
Alamat : ..................................................................................................................
Desa/Keluarahan : ..................................................................................................................

Kepegawaian
Status Kepegawaian : ..................................................................................................................
Jenis PTK : Guru Kelas / Guru Mapel/ Tenaga Administrasi /
Lembaga Pengangkat : ..................................................................................................................
Sumber Gaji : APBN / APBD Prov /APBD Kab / Yayasan / Sekolah / Lainnya
Lisensi Kepala Sekolah : Belum / Sudah

Penugasan
Kecamatan : ..................................................................................................................
NPSN/ Nama Sekolah : ..................................................................................................................
Status Induk : Induk / Bukan Induk
Nomor Surat Tugas : ..................................................................................................................
Tanggal Surat Tugas : ..................................................................................................................
TMT Tugas : ..................................................................................................................

Tambah PTK merupakan fasilitas untuk menambahkan PTK Baru dan Belum Pernah dimasukan
kedalam Data Pokok Pendidikan di sekolah manapun, apabila sudah pernah ditambahkan gunakan
fasilitas Tarik PTK oleh operator sekolah

Lampiran
1. Foto Copy KTP
2. Foto Copy SK Pengangkatan PTK
3. Foto Copy SK Pembagian Tugas