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PABANRIM POLRES KATINGAN

BLANGKO PENDAFTARAN ONLINE TARUNA AKPOL/BINTARA/TAMTAMA POLRI

NO RESGISTRASI :.............................................................................................. GOLONGAN DARAH :

NO RESGIS POLDA :.............................................................................................. TINGGI BADAN
NAMA :.............................................................................................. BERAT BADAN
JENIS KELAMIN :.............................................................................................. SUKU
POLDA :..............................................................................................
POLRES :..............................................................................................
TGL DAFTAR :..............................................................................................
TGL VERIFIKASI :..............................................................................................
( DIISI PANITIA ) :..............................................................................................

I. DATA PRIBADI

TEMPAT DAN TGL LAHIR :..............................................................................................

AGAMADAN SUKU :..............................................................................................
ALAMAT :..............................................................................................

KOTA :..............................................................................................
NO TELP. :..............................................................................................
NO NIK KTP :..............................................................................................
NO KK :..............................................................................................
PRESTASI :..............................................................................................

II. DATA SEKOLAH

SD :..............................................................................................
NAMA SD :..............................................................................................
THN LULUS :............................................
:..............................................................................................
NILAI IJAZAH SD :…...........................................................................................
KOTA ASAL :..............................................................................................
PROVINSI :............................................

SMP :..............................................................................................
NAMA SMP :..............................................................................................
THN LULUS :............................................
NILAI IJAZAH SMP :…...........................................................................................
KOTA ASAL PROVINSI :............................................

SMA :..............................................................................................
NAMA SMA :..............................................................................................
THN LULUS :............................................

KOTA ASAL :..............................................................................................

PROVINSI :............................................
NILAI UN/GAB. N. SKLH :..............................................................................................
N. RAPORT SM I KELAS XII :............................................
JURUSAN :..............................................................................................

III. DATA ORANG TUA

BAPAK KANDUNG
NAMA :..............................................................................................
TTL :..............................................................................................
UMUR :............................................
AGAMA :..............................................................................................
NO TELP :..............................................................................................
NO TELP RUMAH :............................................
ALAMAT :..............................................................................................

KLMPK PEKERJAAN :..............................................................................................

JENIS PEKERJAAN :..............................................................................................
PANGKAT/GOL :..............................................................................................
JABATAN :..............................................................................................
NAMA KANTOR :..............................................................................................
NO TELP KANTOR :..............................................................................................
ALAMAT KANTOR :..............................................................................................
 2
IBU KANDUNG
NAMA :..............................................................................................
TTL :..............................................................................................
UMUR :............................................
AGAMA :..............................................................................................
NO TELP :..............................................................................................
NO TELP RUMAH :............................................
ALAMAT :..............................................................................................

KLMPK PEKERJAAN :..............................................................................................

JENIS PEKERJAAN :..............................................................................................
PANGKAT/GOL :..............................................................................................
JABATAN :..............................................................................................
NAMA KANTOR :..............................................................................................
NO TELP KANTOR :..............................................................................................
ALAMAT KANTOR :..............................................................................................

WALI
NAMA :..............................................................................................
TTL :..............................................................................................
UMUR :............................................
AGAMA :..............................................................................................
NO TELP :..............................................................................................
NO TELP RUMAH :............................................
ALAMAT :..............................................................................................

KLMPK PEKERJAAN :..............................................................................................

JENIS PEKERJAAN :..............................................................................................
PANGKAT/GOL :..............................................................................................
JABATAN :..............................................................................................
NAMA KANTOR :..............................................................................................
NO TELP KANTOR :..............................................................................................
ALAMAT KANTOR :..............................................................................................

ALAMAT MEDIA SOSIAL YG DIMILIKI (CALON PENDAFTAR)

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KASONGAN........................2023

PENDAFTAR

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

CATATAN : CORET YANG TIDAK PERLU

SYARAT PENDAFTARAN ONLINE
1 FOTO COPY KTP, KARTU KELUARGA DAN AKTA LAHIR
2 FOTO COPY IJAZAH DAN SKHUN SD,SMP DAN SMA
3 FOTO COPY RAPORT KELAS XII SM I
4 FOTO UKURAN 4X6 SEBANYAK DALAM BENTUK JPEG LATAR KUNING
BERKAS DIFOTO COPY MASING2 1 RANGKAP DAN DALAM BENTUK PDF UNTUK MASING JENIS BERKAS