DATA PESERTA PRAKTEK KERJA LAPANGAN

Tahun 2020

IDENTITAS SISWA
1. Nama Siswa :.............................................................................
2. Tempat Tgl Lahir :.............................................................................
3. Jenis Kelamin :.............................................................................
4. No. Induk Siswa/ Abs :.............................................................................
5. Kelas :.............................................................................
6. Alamat siswa :.............................................................................
…………………Telp./Hp.……………………
7. Nama Orang Tua/wali :.............................................................................
8. Alamat Orang Tua/Wali :.............................................................................
…………………Telp./Hp.……………………

IDENTITAS SEKOLAH
1. Nama Sekolah :.............................................................................
2. Nama Kepala Sekolah :.............................................................................
3. Alamat Sekolah :.............................................................................
…………………Telp. ………………………..
4. Nama Guru Pembimbing :.............................................................................
5. Alamat Guru Pembimbing :.............................................................................
…………………Telp./Hp. .…………………..

IDENTITAS INDUSTRI
1. Nama Perusahaan :.............................................................................
2. Jenis Usaha :.............................................................................
3. Alamat Lengkap Perusahaan :.............................................................................
…………………Telp. ………………………..
4. Nama Pimpinan :.............................................................................
5. Nama Pembimbing Industri :.............................................................................
6. Alamat Pembimbing Industri :.............................................................................
…………………Telp./Hp ..…………………..