Kepada Yth.
Pusat Pendidikan dan Pelatihan
Deputi Bidang Pengembangan Sumber Daya Perpustakaan
Perpustakaan Nasional RI
Jl. Salemba Raya 28A, Jakarta Pusat 10430
Nama : .............................................................................................................
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Golongan/Ruang : .............................................................................................................
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Jabatan : .............................................................................................................
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Pendidikan Terakhir
: .................................................................................................................................
Unit Kerja
: .................................................................................................................................
Instansi : ...................................................................................................
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Alamat Instansi
: .................................................................................................................................
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No. Telp./Faks.
: .................................................................................................................................
Berminat mengikuti diklat yang diselenggarakan Pusdiklat Tahun 2016. Jenis Diklat
yang akan kami ikuti - telah kami tandai (x) pada Tabel Jadwal Diklat dibawah ini.
Terima kasih.
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2016
Mengetahui
Atasan langsung Calon Peserta
( cap kantor )
( ....................... ) ( ...................... )