FORMULIR BIODATA PESERTA

LATSAR CPNS GOLONGAN II PEMERINTAH KAB. MAMUJU

KERJASAMA BPSDM PROVINSI SULAWESI BARAT
TAHUN 2019

1. NIP
2. Nama Lengkap
3. Tempat/Tgl. Lahir
4. Pangkat, Gol. Ruang
6. Pendidikan Terakhir
7. Agama
8. Jenis Kelamin
9. Instansi
10. Alamat Instansi
11. Alamat Rumah
12. No. HP
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:  D3  S2 ................................................................
:  Islam  Katolik  Protestan
 Hindu  Budha
:  Laki-Laki  Perempuan
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Mamuju, ......................... 2019

Peserta Latsar CPNS
Pemerintah Kab. Mamuju,

3x4

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Keterangan :
1. Diisi secara lengkap dan benar;
2. Mengumpulkan pas foto ukuran 4x6 sebanyak 2 lembar ke panitia;
3. Menuliskan nama, angkatan/kelas, no. absen di lembar belakang pas foto;
4. Dikumpulkan ke panitia;
5. Jika ada kesulitan dalam pengisian silahkan menghubungi panitia.