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Kode Dok : F-PLG- 000

Revisi :1

BIODATA PETUGAS/PANITIA
PROGRAM PENINGKATAN KOMPETENSI PEMBELAJARAN BERBASIS ZONASI
BAGI GURU
di .....................................................................................................................,
Tanggal ........................................................... s.d. ..............................................................

1. Nama (lengkap dengan titel) : ................................................................................................


2. Tempat dan Tanggal Lahir : ................................................................................................
3. NIP : ................................................................................................
4. NPWP : ................................................................................................
5. NIK (Nomor Induk Kependudukan) : ................................................................................................
6. Pangkat, Golongan : ................................................................................................
7. Jabatan : ................................................................................................
8. Agama : ................................................................................................
9. Jenis Kelamin : Laki-laki / Perempuan
10. Unit Kerja : ................................................................................................
11. Alamat Unit Kerja : ................................................................................................
 ............................................................................................
12. Alamat Rumah : ................................................................................................

 ..................................... ................................................
13. Alamat Email : ................................................................................................

..............., …...................

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

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