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Format Biodata Sertifikasi Guru

Format Biodata Sertifikasi Guru

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Published by: adhyatnika geusan ulun on Dec 10, 2009
Copyright:Attribution Non-commercial

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04/12/2013

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BIODATA PESERTA SERTIFIKASI GURU TAHUN 2009KELURAHAN/KECAMATAN
: ………………………………………………………………………………………………………
KABUPATEN/KOTA
: ………………………………………………………………………………………………………
PROPINSI
: ………………………………………………………………………………………………………
NOMOR PESERTA
: ………………………………………………………………………………………………………
1.IDENTITASa.
INSTANSI/NAMA SEKOLAH
b.
NAMA LENGKAP
c.
NIP/NIK
d.
GELAR AKADEMIK
e.
TEMPAT LAHIR
f.
TGL_LAHIR
//g.
JENIS KELAMIN
1. Laki-Laki2. Perempuan
h.
AGAMA
1. Islam2. Protestan3. Katholik4. Hindu5. Budha6. Khong Hu Chu
i.
STATUS KAWIN
1. Kawin2. Belum Kawin3. Duda/Janda
 j.
STATUS KEPEGAWAIAN
1. PNS :a. Pendidikb. Tenaga Kependidikan2. Non PNS :a. Guru Tetape. Guru Honor Daerahb. Guru Tidak Tetapf. Guru Sukarelawanc. Guru Bantug. Lainnya d. Guru Yayasan
k.
PANGKAT/GOLONGAN
1. I/a2. I/b3. I/c4. I/d5. II/a6. II/b
(Khusus PNS)
7. II/c8. II/d9. III/a10. III/b11. III/c12. III/d13. IV/a14. IV/b15. IV/c16 IV/d17. IV/e18. lainnya
l.TMT PNS
//
m.TMT_TUGAS
//
n.NO KTPo.ALAMAT_RUMAH(Sesuai KTP)
RTRW
KELURAHANKECAMATANKABUPATEN/KOTAPROPINSIKODE POSp.TELEPON RUMAH
-
q.NO HP
2.SUAMI/ISTRIa.Nama Suami/Istri:b.Pekerjaan1. PNS2. Non PNSc.NIP(apabila suami/istri sebagai PNS)
 
3.ANAKa.Jumlah AnakNamaStatus AnakTempat LahirTanggal LahirTahun Masukb.Nama Orangtua (Ibu Kandung):4.BEASISWANo.JenisPenyelenggaraSumber DanaTahun Masukawalakhi5.INFORMASI STUDI BANDINGNo.Jenis Studi BandingPenyelenggaraTahunSumber DanaTujuan (Tempat)6.HASIL NILAI UJIAN DAN UAN YANG DIAJARKANNo.Mata PelajaranNilai TertinggiNilai TerendahTahunJumlah Siswa7.INFORMASI TUNJANGANNo.Jenis TunjanganTahun MenerimaInstansi yang MemberiSumber Dana8.LAIN - LAIN
………………………………………………………………………………………………………………………………………………………….………………………………………………………………………………………………………………………………………………………….………………………………………………………………………………………………………………………………………………………….………………………………………………………………………………………………………………………………………………………….………………………………………………………………………………………………………………………………………………………….………………………………………………………………………………………………………………………………………………………….………………………………………………………………………………………………………………………………………………………….
Mengetahui :PesertaKepala Sekolah :2009…………………………………………..Kab/Kota ……………………………….
JenjangSekolah

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