Indikator
Jumlah
Kedisiplinan Kepemimpinan Kerjasama Prakarsa (5%)
No. Nama Peserta
Bobot Bobot Bobot Bobot
Nominal Nominal Nominal Nominal
(1%) (2%) (1%) (1%)
1 2 3 4 5 6 7 8 9 10 11
1.
SURAT KETERANGAN
Nomor : ........................................................
Menerangkan bahwa :
Nama : .............................................................................
NIP : .............................................................................
Pangkat/Gol : .............................................................................
Jabatan : .............................................................................
Unit Kerja : .............................................................................
Nama
NIP