FORMULIR PERMOHONAN PELATIHAN

INTERNAL/EKSTERNAL *

Nama : ..............................................................................................

NIK : ..............................................................................................

Jabatan : ..............................................................................................

Unit : ..............................................................................................

Jenis Pelatihan : ..............................................................................................

Waktu Pelaksanaan : ..............................................................................................

Tempat Pelaksanaan : ..............................................................................................

Biaya Pelatihan : Rp.............................................................................

Dibiayai Oleh a. Mandiri
b. Rumah sakit
c. Sponsorship ...............................................................

Nilai Ikatan Dinas : ..............................................................................................

Selama pelatihan diganti oleh : ..............................................................................................

Bogor, ......................................
Diajukan oleh Diketahui Oleh
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