BIODATA

1. NAMA LENGKAP : ..........................................................................................................

2. TEMPAT, TANGGAL LAHIR : ..........................................................................................................

3. NIP : ..........................................................................................................

4. PANGKAT/GOLONGAN : ..........................................................................................................

5. UNIT KERJA : ..........................................................................................................

ALAMAT : ..........................................................................................................

KELURAHAN : ..........................................................................................................

KECAMATAN : ..........................................................................................................

KAB./KOTA : ..........................................................................................................

NO. TELP. : ..........................................................................................................

6. ALAMAT RUMAH : ..........................................................................................................

NO. TELPON : ..........................................................................................................

NO. HP : ..........................................................................................................

7. NPWP : ..........................................................................................................

8. NOMOR REKENING : ..........................................................................................................

BANK : ..........................................................................................................

Pasuruan,
Yang membuat,

.................................
 SURAT PERNYATAAN KESEDIAAN

Yang bertanda tangan dibawah ini :

Nama : ...............................................................................................................................
Jabatan : ...............................................................................................................................
Unit Kerja : ...............................................................................................................................

Menyatakan bersedia menjadi Proktor Sinkronisasi dan Pelaksanaan ANBK SD pada kegiatan
diselenggarakan pada :

Hari : ...............................................................................................................................
Tanggal : ...............................................................................................................................
Tempat : ...............................................................................................................................
Kegiatan : ...............................................................................................................................

Demikian pernyataan ini saya buat dengan penuh rasa tanggung jawab.

…………..,…………………….
Yang membuat pernyataan,

.................................
*) coret yang tidak perlu

DAFTAR RIWAYAT HIDUP

 Curriculum Vitae
I. Data Pribadi
1. Nama : ..........................................................................................................
2. Tempat, Tanggal Lahir : ..........................................................................................................
3. Jenis Kelamin : ..........................................................................................................
4. Agama : ..........................................................................................................
5. Status Perkawinan : ..........................................................................................................
6. Warga Negara : ..........................................................................................................
7. Alamat KTP : ..........................................................................................................
..........................................................................................................
..........................................................................................................
8. Alamat Sekarang : ..........................................................................................................
..........................................................................................................
..........................................................................................................
9. Nomor Telepon / HP : ..........................................................................................................
10. E-Mail : ..........................................................................................................
11. Kode Pos : ..........................................................................................................

II. Pendidikan Formal

Periode Sekolah / Institusi / Jenjang IPK / UAN
Jurusan
(Tahun) Universitas Pendidikan RAPOR
-
-
-
-
-

III. Pendidikan Non Formal / Training – Seminar

Tahun Lembaga / Instansi Keterampilan

IV. Riwayat Pengalaman Kerja

Periode
Instansi / Perusahaan Jurusan
(Tahun)
-
-
-
-
-

V. Penguasaan Bahasa
 Kemampuan
No. Bahasa
Membaca Menulis Berbicara Mendengar

VI. Lain – Lain

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

Demikian CV ini saya buat dengan sebenarnya.

……………….,…………………………….

(……………………………..)

SURAT TUGAS