Form Biodata

BIODATA PESERTA
Nama Kegiatan : Seleksi Subtantif Bakal Calon Kepala Sekolah jenjang,
TK/PAUD, SD dan SMP Lingkup Dinas Pendidikan dan
Kebudayaan Kabupaten Buton Tengah Tahun 2021

Tanggal Pelaksanaan : 31 Agustus s.d. 2 September 2021

Nama Lengkap : ....................................................................................................
Tempat dan tanggal lahir : ....................................................................................................
Jenis kelamin : Laki-Laki / Perempuan *
Agama : ....................................................................................................
NIP : ....................................................................................................
Pangkat dan golongan ruang : ....................................................................................................
NUPTK : ....................................................................................................
No. UKG : ....................................................................................................
NRG : ....................................................................................................
Pendidikan terakhir : …...… Jurusasn .........................................................................
Tgl./Bulan/Tahun Pensiun : ....................................................................................................
Jabatan : ....................................................................................................
Nama Sekolah : ....................................................................................................
NPSN / NSS : ....................................... / .........................................................
Alamat Sekolah Jalan : ........................................................... No .....
Desa / Kel.* : ........................................................................
Kecamatan : ........................................................................
Kabupaten : Buton Tengah
Provinsi : Sulawesi Tenggara
Telepon/Fax : ........................................................................
e-mail : ........................................................................
Alamat Rumah Jalan : ........................................................... No ......
Desa / Kel.* : ........................................................................
Kecamatan : ........................................................................
Kabupaten : Buton Tengah
Provinsi : Sulawesi Tenggara
No. HP / WA : ....................................................................................................
e-mail Pribadi : ....................................................................................................
NIK : ....................................................................................................
NPWP : ....................................................................................................
Labungkari, Agustus 2021
Yang membuat,

Pas foto

3x4 cm

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NIP
Catatan
1. Tulis dengan menggunakan huruf kapital/besar
2. * Coret yang tidak perlu