Formulir PTK Baru

Identittas

Nama Lengkap : .......................................................................................................................

Jenis Kelamain : .......................................................................................................................
Tempat, Tanggal Lahir : .......................................................................................................................
NIK : .......................................................................................................................
NUPTK :
Pastikan NUPTK valid, karena setelah disimpan tidak dapat diperbaiki dari
aplikasi dapodik
Agama : .......................................................................................................................
Nama Ibu Kandung : .......................................................................................................................
Status Perkawinan : .......................................................................................................................
No. HP : .......................................................................................................................

Domisili

Propinsi : .......................................................................................................................
Kabupaten/kota : .......................................................................................................................
Kecamatan : .......................................................................................................................
Alamat : .......................................................................................................................
Desa/Kelurahan : .......................................................................................................................

Kepegawaian

Status Kepegawaian : .......................................................................................................................

Jenis PTK : Guru Kelas / Guru Mapel / Tenaga Administrasi/…………………………
Lembaga Pengangkat : .......................................................................................................................
Sumber Gaji : APBN / APBD Prov / APBD Kab / Yayasan / Sekolah / Lainnya
Lisensi Kepala Sekolah : Belum / Sudah

Penugasan

Kecamatan : .......................................................................................................................
NPSN / Nama Sekolah : .......................................................................................................................
Status Induk : .......................................................................................................................
Nomor Surat Tugas : .......................................................................................................................
Tanggal Surat Tugas : .......................................................................................................................
TMT Tugas : .......................................................................................................................

Tambah PTK merupakan fasilitas untuk menambahkan PTK Baru dan Belum Pernah dimasukan kedalam Data
Pokok Pendidikan di sekolah manapun, apabila sudah pernah ditambahkan gunakan fasilitas Tarik PTK oleh
Operator Sekolah

Lampiran
Foto Copy KTP
Foto Copy SK Pengangkatan PTK
Foto Copy SK Pembagian Tugas