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BIODATA PESERTA SELEKSI CALON PRAJA IPDN

warna 3x4
TAHUN 2014

No Test :...................

I. ASAL DAERAH
a. Provinsi :.....................................................
b. Kabupaten/Kota :.....................................................

II. IDENTITAS PESERTA

a. Nama Lengkap :.....................................................
b. Tempat/ Tgl.Lahir :.....................................................
c. Jenis Kelamin :.....................................................
d. Agama :.....................................................
e. Tinggi Badan :.....................................................
f. Berat Badan :.....................................................
g. Alamat Domisili :.....................................................

III. PENDIDIKAN
a. Jenis Sekolah : (SMA/MA)*
b. Nama Sekolah :.....................................................
- Tahun Lulus : 2012/2013/2014*
- Rangking :.....................................................
- Nilai Rata-Rata :.....................................................
c. STTB/IJAZAH :.....................................................
Jurusan :.....................................................

IV. ORANG TUA

a. Nama Ayah :.....................................................
Pekerjaan :.....................................................
b. Nama Ibu :.....................................................
Pekerjaan :.....................................................
c. Alamat Orang Tua :.....................................................
.................................................................................................

........,.....................,2014
Calon Praja IPDN

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*) coret yang tidak perlu