Anda di halaman 1dari 1

PEREKAMAN DATA PTK TAHUN 2020

IDENTITAS
1 NIK ..........................................................
2 NAMA LENGKAP (SESUAI KTP/KK) ..........................................................
3 TEMPAT LAHIR .........................................................
4 TANGGAL LAHIR ..........................................................
5 JENIS KELAMIN ..........................................................
6 NAMA IBU KANDUNG ..........................................................
7 AGAMA ..........................................................
8 STATUS PERKAWINAN ..........................................................
9 EMAIL AKTIF ..........................................................
DOMISILI
10 KAB/KOTA ..........................................................
11 KECAMATAN ..........................................................
12 ALAMAT ..........................................................
13 KELURAHAN ..........................................................
14 KODE POS ..........................................................
KEPEGAWAIAN
15 STATUS KEPEGAWAIAN ..........................................................
16 NIP ..........................................................
17 JENIS PTK ..........................................................
18 LEMBAGA PENGANGKAT ..........................................................
19 NOMOR SK PENGANGKATAN ..........................................................
20 TMT ..........................................................
21 SUMBER GAJI (APBD/APBN/SEKOLAH) ..........................................................
22 LISENSI KEPALA SEKOLAH * ..........................................................
PENUGASAN
23 KAB/KOTA ..........................................................
24 NAMA SEKOLAH ..........................................................
25 NOMOR SK PENGANGKATAN ..........................................................
26 TANGGAL SURAT TUGAS ..........................................................
27 TMT

MENGETAHUI
KEPALA SEKOLAH

NAMA
NIP.........................

*TTD CAP BASAH

Anda mungkin juga menyukai