Lampiran X

Pengumuman
Nomor : KP.01.04/IV/9180/2022
Tanggal : 31 Oktober 2022

FORMAT PORTOFOLIO PELAMAR JABATAN DOKTER AHLI MADYA SELEKSI PPPK

KEMENTERIAN KESEHATAN TAHUN 2022

PORTOFOLIO PELAMAR JABATAN DOKTER AHLI MADYA

SELEKSI PPPK KEMENTERIAN KESEHATAN TAHUN 2022

1. Identitas diri meliputi:

a. Nama : ………………………………………………………………………….
b. Tempat Tgl Lahir : ………………………………………………………………………….
c. Email : ………………………………………………………………………….
d. Nomor Telp/HP : ………………………………………………………………………….

2. Riwayat Pendidikan:
a. SMA : ………………………………………………………………………….
b. Sarjana : ………………………………………………………………………….
c. Profesi : ………………………………………………………………………….
d. Spesialis : ………………………………………………………………………….
e. Lain – lain : ………………………………………………………………………….

3. Profil pekerjaan saat ini:

a. Deskripsi Pekerjaan
.......................................................................................................................................
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(uraian tugas)
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b. Unit Kerja / Instansi
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4. Riwayat Jabatan/Pekerjaan yang dibuktikan dengan laporan kinerja dan disahkan oleh
pimpinan satuan kerja (bagi pelamar dengan kualifikasi pendidikan dokter spesialis harus
mengisi pada huruf a dan bagi pelamar dengan kualifikasi pendidikan dokter harus mengisi
pada huruf b).
a. Bagi Pelamar dengan Kualifikasi Pendidikan Dokter Spesialis
1) Pengalaman pelayanan medik dan penunjang Spesialistik
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2) Pengalaman pelayanan Spesialistik konsultan sesuai persyaratan jabatan
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b. Bagi Pelamar dengan Kualifikasi Pendidikan Dokter

1) Pengalaman pelayanan medis dan penunjang medis terkait pasien kanker
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2) Pengalaman pelayanan darurat medis
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5. Riwayat Pengembangan Profesi

a. Karya Ilmiah yang dipublikasikan di jurnal internal atau nasional atau internasional
(dibuktikan dengan abstrak hasil penulisan karya ilmiah); atau
.......................................................................................................................................
.......................................................................................................................................
.......................................................................................................................................
.......................................................................................................................................
b. Hasil penulisan Buku atau pedoman atau SOP sesuai spesialisasi yang telah disahkan
oleh pimpinan instansi terkait/organisasi profesi/terdaftar pada ISBN (dibuktikan dengan
buku/ pedoman/SOP); atau
.......................................................................................................................................
.......................................................................................................................................
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c. Penghargaan atas prestasi sesuai spesialisasi secara internal atau nasional atau
internasional (dibuktikan dengan sertifikat/piagam); dan
.......................................................................................................................................
.......................................................................................................................................
.......................................................................................................................................
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d. Sertifikat Pelatihan/Workshop terkait dengan jabatan yang dilamar yang
dikeluarkan/diakui oleh organisasi profesi/instansi pemerintah/instansi yang berwenang
lainnya; atau
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.........................................................................................................................................
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e. Pembicara dalam seminar atau workshop tentang kompetensinya (dibuktikan dengan
sertifikat/piagam)
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 6. Riwayat Pelatihan dan Pengembangan Kompetensi
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Mengetahui, .............., .................... 2022

Yang membuat pernyataan,
Stempel
Unit (ttd) (ttd)
Kerja

Pimpinan Satuan Kerja ...........................................