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PUSDIKLAT MANAJEMEN DAN KEPEMIMPINAN

BALITBANG DIKLAT KUMDIL


MAHKAMAH AGUNG RI Foto 4x6

BIODATA PESERTA DIKLAT


MAHKAMAH AGUNG RI TAHUN ANGGARAN 2013

I. DATA PRIBADI
1. Nama Lengkap + Gelar : .............................................................................
2. NIP : .............................................................................
3. No. Seri KARPEG : .............................................................................
4. Tempat/Tgl. Lahir/Usia : .............................................................................
5. Agama : .............................................................................
6. Email : .............................................................................
7. Unit Kerja/ Instansi : .............................................................................
8. Alamat Kantor/Telp./Fax. : .............................................................................
Telp: ........................... Fax : ...............................
9. Alamat Rumah/ Telp./Fax./HP : .............................................................................
Telp: ........................... Fax : ...............................
HP : .....................................

II. DATA KERJA/JABATAN


1. Data PNS
a. Pengangkatan PNS Tahun : .............................................................................
b. Golongan/Jabatan : .............................................................................
c. Pendidikan : .............................................................................
d. Unit Kerja/Instansi : .............................................................................
e. Total Masa Kerja PNS : .............................................................................
2. Latar Belakang Pendidikan
a. Strata 1 : .............................................................................
b. Strata 2 : .............................................................................

III. NAMA KEGIATAN DIKLAT : .............................................................................

............................, ......................... 2013

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NIP. .................................................

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