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BIODATA PENGUJI

KEGIATAN REKRUITMEN CALON PELATIH DAERAH


PROGRAM PENGEMBANGAN KEPROFESIAN BERKELANJUTAN
DILINGKUNGAN KANTOR WILAYAH KEMENTERIAN AGAMA PROVINSI BANTEN
TAHUN 2022

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

Tempat Tanggal Lahir : .................................................................................

NIP./NUPTK : .................................................................................

Pangkat/Golongan : .................................................................................

SK Pengangkatan*) : .................................................................................

Jabatan : .................................................................................

Satuan Kerja : .................................................................................

No. HP : .................................................................................

Alamat Instansi/Kantor/Sekolah : .................................................................................

.................................................................................

................................................................................

NPWP : .................................................................................

No Rekening : .................................................................................

Bank : .................................................................................

Nama Sesuai Rekening : .................................................................................

Serang, 01 November 2022


penguji,

.........................................................
NIP.

*) diisi dengan “Kementerian Agama / Dinas Pendidikan Kabupaten/Kota/Provinsi”

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