BIODATA PESERTA

Kegiatan Penyusunan Pedoman Formasi JF PTP

Hotel Horison Ciledug, 24 s.d. 27 Mei 2018

NAMA : _________________________________________________

NIP : _________________________________________________

TEMPAT, TGL LAHIR : _________________________________________________

JENIS KELAMIN : LAKI-LAKI / PEREMPUAN

NPWP : _________________________________________________

PANGKAT/GOLONGAN : _________________________________________________

JABATAN : _________________________________________________

INSTANSI : _________________________________________________

ALAMAT INSTANSI : _________________________________________________

_________________________________________________

TELP : _________________________________________________

FAX : _________________________________________________

EMAIL : _________________________________________________

ALAMAT RUMAH : _________________________________________________

TELEPON : _________________________________________________

HP : _________________________________________________

E-MAIL : _________________________________________________

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Catatan:
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 Tulis dengan huruf cetak;
 Mohon di isi dengan lengkap dan NIP.
dikembalikan ke panitia.