KARTU PENDAFTARAN SDM LINI LAPANGAN

K/0/PKB/20
PETUGAS LAPANGAN KB DAN PENYULUHAN KB
7 6 0 3 B 1B 2 1
Kode Provinsi Kode Kabupaten/ Kode Tenaga Nomor Register
Kota Program PKB/PLKB

1. NAMA : RIZKY KURNIYANTI J

2. TANGGAL LAHIR : MAMUJU, 18-02-1995
3. ALAMAT
a. Jalan : JL POROS LAKAHANG-MAMASA
b. Desa/Kelurahan : LAKAHANG 1 0 0 1

c. Kecamatan : TABULAHAN 0 5
d. Kabupaten/Kota : MAMASA 0 3
e. Provinsi : SULAWESI BARAT 7 6
f. No. HP : 081524145181 Email : rizky kurniyantij@gmail.com
g. Nama Akun Media Sosial :
 1. Ada, Sebutkan FB: Rizky Kurniyanti J 2. Tidak Ada

4. JENIS KELAMIN : (L/P)

5. NAMA JABATAN PETUGAS KB TINGKAT DESA/KELURAHAN :
* Centang Salah Satu

 1. PKB  a. Trampil d. Pertama g. Utama

b. Mahir e. Muda
c. Penyelia f. Madya
2. PLKB a. PNS
b. Non PNS

6. SK PENGANGKATAN (PLKB Non PNS) : 1. Ada  2. Tidak Ada

a. SK : Nomor Tanggal

b. Dikeluarkan Oleh : 1. Gubernur 2. Sekda/Bupati/Walikota 3. PD KB

7. NIP : 1 9 9 5 0 2 1 8 2 0 2 3 2 0 2 1 2 7
8. NIK : 7 6 0 2 0 5 5 8 0 2 9 5 0 0 0 1

9. PENDIDIKAN TERAKHIR : 1. SMA 2. D1  3. D2 4. D3 5. D4/S1 6. S2 7. S3

PROGRAM STUDI : 1. Dokter 2. Perawat  3. Bidan 4. Lainnya, ............ (Kode)

10. PANGKAT & GOLONGAN :
: Refreshing
11. P* DEaLpA
at T
diIpH
ilihA
leN
bih F
daU
ri N
satG
u SIONAL
1. LDU 3. Penjenjangan 4. Belum Terlatih

12. P* EDaLpA TIHAN TEKNIS

at dipilih lebih dari satu
:2.  1. Pencatatan & Pelaporan 4. KIE 7. Belum Terlatih
2. KIP/Konseling 5. Kependudukan 8. Pembangunan Keluarga
3. Advokasi 6. Substansi Lainnya

13. PERLENGKAPAN Tahun Perolehan Tahun Perolehan

: 1. PLKB Kit 4. Android
2. KIE Kit 5. Sarana Lainnya
3. Sepeda Motor 6. Belum Memiliki

Kode Kualifikasi Pendidikan Bidang Ilmu Sosial atau Kualifikasi Pendidikan Lain Yang Relevan :

a : Ilmu Komunikasi k : Ilmu Pemerintahan

b : Hubungan Masyarakat l : Ilmu Manajemen
c : Manajemen Komunikasi dan Media m : Kebijakan Publik
d : Komunikasi Penyiaran Islam n : Studi Pembangunan (Perencanaan Pembangunan, Wilayah, Kota)
e : Ilmu Kesejahteraan Sosial o : Psikologi Umum
f : Sosiologi p : Kesehatan Masyarakat
g : Antropologi q : Ilmu Keluarga
h : Ilmu Sosiatri r : Pendidikan Anak Usia Dini
i : Kependudukan (Demografi) s : Pendidikan Luar Sekolah
j : Ilmu Administrasi (Niaga, Negara, Publik, Pembangunan, dll) t : Pendidikan Kependudukan dan Lingkungan Hidup
14. KELURAHAN/DESA BINAAN :
* Jika Lebih Dari Satu, Tulis Semua Desanya
Kode Wilayah
1. PANGANDARAN 2 0 1 1
2. TALOPAK 2 0 1 2
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Menyetujui,
KEPALA PD KB Kab/Kota
( ........................................................ )
Kode Wilayah
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TABULAHAN , 15 OKTOBER 2023
PKB/PLKB Kecamatan TABULAHAN
( ESTER )