SURAT LAMARAN

KEPADA
YTH, MENTERI AGAMA REPUBLIK INDONESIA
DENGAN HORMAT,
YANG BERTANDA TANGAN DI BAWAH INI:

NAMA : MUH. FADHIL SUPRIADI

TEMPAT, TANGGAL LAHIR : MAKASSAR, 28 MEI 1996
AGAMA : ISLAM
KEWARGANEGARAAN : INDONESIA
PENDIDIKAN TERAKHIR : S-1 PENDIDIKAN TEKNIK INFORMATIKA DAN
KOMPUTER
ALAMAT : BTN TABARIA TOWER BLOK E10 NO. 09
NOMOT TELP./HANDPHONE : 081526023180
(YANG DAPAT DIHUBUNGI)

DENGAN INI MENGAJUKAN PERMOHONAN UNTUK DAPAT MENGIKUTI UJIAN

CALON PEGAWAI NEGERI SIPIL KEMENTERIAN AGAMA TAHUN 2019 DENGAN
JENIS KETENAGAAN AHLI PERTAMA – GURU TIK.

SEBAGAI BAHAN PERTIMBANGAN, KAMI LAMPIRAN:

1. SURAT LAMARAN
2. SWAFOTO DENGAN KARTU INDENTITAS DAN KARTU INFORMASI AKUN SSCASN
3. PASFOTO UKURAN 4X6 LATAR BELAKANG MERAH
4. KARTU TANDA PENDUDUK (KTP)
5. KARTU KELUARGA (KK)
6. IJAZAH DAN TRANSKIP NILAI
7. AKREDITAS PERGURUAN TINGGI DAN PROGRAM STUDI
8. SURAT PERNYATAAN BEBAS NARKOBA
9. SURAT PERNYATAAN SIAP DITEMPATKAN DI SELURUH WILAYAH NKRI

DEMIKIAN PERMOHONAN INI SAYA BUAT DENGAN SEBENARNYA. APABILA DI

KEMUDIAN HARI TERNYATA DATA YANG DISAMPAIKAN TIDAK BENAR, SAYA
BERSEDIA DITUNTUT DI PENGADILAN.

ATAS PERHATIAN DAN PERKENAN BAPAK, SAYA UCAPKAN TERIMA KASIH.

MAKASSAR, 20 NOVEMBER 2019

MUH. FADHIL SUPRIADI

 SURAT PERNYATAAN BEBAS NARKOBA

Dengan hormat,
Yang bertanda tangan di bawah ini:

Nama : Muh. Fadhil Supriadi

Tempat, tanggal lahir : Makassar, 28 Mei 1996
Agama : Islam
Kewarganegaraan : Indonesia
Pendidikan Terakhir : S-1 Pendidikan Teknik Informatika dan Komputer
Alamat : BTN Tabaria Tower Blok E10 No.09
Nomor Telp./Handphone : 081526023180
(yang dapat dihubungi)

Dengan ini saya menyatakan bahwa saya tidak pernah dan tidak akan terlibat dalam
penggunaan dan/atau pendistribusian Obat-Obatan Terlarang, Narkoba, Zat Adiktif, dan
Psikotropika.
Demikian pernyataan ini saya buat dengan sesungguhnya, apabila pernyataan saya ini
ternyata dikemudian hari tidak benar, maka saya bersedia dituntut di pengadilan sesuai
peraturan perundang-undangan yang berlaku.

Makassar, 20 November 2019

Muh. Fadhil Supriadi

 SURAT PERNYATAAN BERSEDIA DITEMPATKAN

SURAT PERNYATAAN

Yang bertanda tangan di bawah ini :

Nama : Muh. Fadhil Supriadi

Tempat, tanggal lahir : Makassar, 28 Mei 1996
Agama : Islam
Alamat : BTN Tabaria Tower Blok E10 No.09

Dengan ini menyatakan dengan sesungguhnya, bahwa saya bersedia mengabdi pada Satuan
Kerja di Kementerian Agama dan tidak akan mengajukan pindah dengan alasan apapun
sekurang-kurangnya selama 10 (sepuluh) tahun sejak TMT PNS.

Demikian pernyataan ini saya buat dengan sesungguhnya, dan saya bersedia dituntut di muka
pengadilan serta bersedia menerima segala tindakan yang diambil oleh pemerintah, apabila
dikemudian hari terbukti pernyataan saya ini tidak benar.

Makassar, 20 November 2019

Muh. Fadhil Supriadi

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