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PEMERINTAH KABUPATEN HULU SUNGAI UTARA

DINAS KESEHATAN
Jl. H. Kurdi Yusni No.066 Telp. (0527) 61406 Amuntai Kode 71418
Kabupaten Hulu Sungai Utara Provinsi Kalimantan Selatan
Email : keshsu@yahoo.com

BIODATA PESERTA UJI KOMPETENSI TENAGA KESEHATAN

NAMA : ...........................................................................

NIP : ...........................................................................

PANGKAT/GOL : ...........................................................................

NO SK PANGKAT : ...........................................................................

TMT PANGKAT :............................................................................

KATEGORI JABFUNG : Terampil / Ahli

TMT JABFUNG :............................................................................

JENJANG SAAT INI :............................................................................

JENJANG YANG DIUJIKAN :............................................................................

NILAI PAK TERAKHIR :............................................................................

INSTANSI / UNIT KERJA :............................................................................

NO TELPON :............................................................................

Amuntai,………………..2020
Peserta,

Nama.....................................
NIP........................................

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