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Ruteng, ...... - ..................

2016

Kepada
Yth. Kepala Badan Kepegawaian Daerah
Kab. Manggarai
Di
Tempat

Dengan hormat,
Yang Bertanda tangan di bawah ini :
Nama :
NIP :
Pangat/Gol :
Jabatan :

Dengan ini mengajuan permohonan untuk tidak melaksanakan Tugas Dinas selama .....
hari yaitu tanggal ........................... , karena ada ......................................
Demikian surat permohonan ini dibuat atas kebijakan dan perhatiannya disampaikan
limpah terimakasih.

Pemohon,

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

Pertimbangan Atasan :
............................................................................................................................................................
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JURNAL HARIAN

NAMA : ANTONIA LISDIANI AMAT


NIP : 19840903 201001 2 024

No Jam Uraian Hasil/Out Put Keterangan

Ruteng , ..............- ................. 2016


Mengetahui
Atasan Langsung Pelapor

KONSTANTINUS E.G HEMO, S.Sos ANTONIA LISDIANI AMAT, S.Kom


NIP. 19710427 200012 1 004 NIP. 19840903 201001 2 024

JURNAL HARIAN
NAMA : .........................................................
NIP : .........................................................
HARI/TANGGAL : .........................................................

No Jam Uraian Hasil/Out Put Keterangan

Ruteng , ..............- ................. 2016


Mengetahui
Atasan Langsung Pelapor

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

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