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Formulir Sertifikasi Pai Madrasah

Formulir Sertifikasi Pai Madrasah

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Published by Umar Faruq

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Published by: Umar Faruq on Apr 26, 2012
Copyright:Attribution Non-commercial

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04/26/2012

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PROPINSI
: JAWA BARAT
KABUPATEN
: TASIKMALAYANomor Peserta :1. NAMA LENGKAP : .............................................................................................................2.GELAR AKAMDEMIK :.............................................................................................................3TEMPAT, TGL LAHIR :.............................................................../ 4 JENIS KELAMIN :Laki - laki Perempuan5 NAMA GADIS IBU KANDUNG :.............................................................................................................6 NIP (Jika PNS) :7NUPTK (harus diisi) : - - -8 NAMA MADRASAH SATMINKAL :.............................................................................................................9 NOMOR POKOK SATMINKAL :.............................................................................................................10 ALAMAT MADRASAH :.............................................................................................................a. Jalan, RT/RW :............................................................................................................. 
FORMULIR PENDAFTARAN PESERTA SERTIFIKASI GURU RA/MADRASAH TAHUN 2012
..............................................................................................................c. Kecamatan :.............................................................................................................d. Kabupaten/Kota :.............................................................................................................e. Telepon / faksimili :.............................................................................................................11 PENDIDIKAN TERAKHIRa. SLTA Jurusan ................................. : Lulus tahun Nama SLTA .............................................b. D-1 Jurusan ................................. : Lulus tahun Nama PT .............................................c. D-2 Jurusan ................................. : Lulus tahun Nama PT .............................................d. D-3 Jurusan ................................. : Lulus tahun Nama PT .............................................e. S-1 Jurusan ................................. : Lulus tahun Nama PT .............................................f. S-2 Jurusan ................................. : Lulus tahun Nama PT .............................................g. S-3 Jurusan ................................. : Lulus tahun Nama PT .............................................h. Akta yang dimiliki ................................. : II III IV12 PERTAMA KALI MEJADI GURU : Mulai / 13 MENJADI GURU PADA SATMINKAL : Mulai / 14DIANGKAT SEBAGAI CPNS: Mulai / 15 DIANGKAT PNS: Mulai / 16 GOLONGAN / PANGKAT SEKARANG :............................................17 STATUS KEPEGAWAIAN :PNS Kementerian Agama PND Diknas PNS Pemda:Non PNS18 Mata Pelajaran yang diampu pada Satminkal :1............................................( tuliskan semua jika > 1 )2............................................3............................................

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