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FORMULIR A1 GPAI 2012

FORMULIR A1 GPAI 2012

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Published by Umar Faruq

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Published by: Umar Faruq on May 15, 2012
Copyright:Attribution Non-commercial

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11/17/2012

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PROVINSI
:
JAWA BARATKABUPATEN/KOTA *)
:
TASIKMALAYANomor Peserta
:1Nama lengkap :2Gelar akademik:3Tempat, tanggal lahir://4Jenis kelamin:laki-lakiperempuan5Nama gadis ibu kandung:6NIP (bagi PNS):7NUPTK (jika ada):8Nama Sekolah SATMINKAL:9Nomor Pokok Statistik SATMINKAL (NSM):10Alamat Sekolah SATMINKAL:aJalan, RT/RW:bKelurahan:cKecamatan:dKabupaten/Kota**):eTelepon/Faksimili:11Pendidikan terakhir aSLTA,jurusan:Lulus thn :nama SLTA:bD-1,jurusan:Lulus thn :nama PT:cD-2,jurusan:Lulus thn :nama PT:dD-3,jurusan:Lulus thn :nama PT:eS-1,Jur./Prod.:Lulus thn :nama PT:fS-2,Jur./Prod.:Lulus thn :nama PT:gS-3,Jur./Prod.:Lulus thn :nama PT:hakta yang dimiliki:IIIIIIV12Menjadi GURU/mengajar (pertama kali):mulai//13Menjadi Guru pada SATMINKAL:mulai//14Diangkat sebagai CPNS:mulai//15Diangkat PNS:mulai//16Golongan/Pangkat sekarang:/17Status kepegawaian:PNS KemenagPNS Instansi lain (diperbantukan)Non-PNS18Mata pelajaran yang DIAMPU pada:1.SATMINKAL (tuliskan semua jika >1 ):2.:3.
FORMULIR PENDAFTARAN PESERTA SERTIFIKASI GURU PENDIDIKAN AGAMA ISLAM (GPAI) TAHUN 2012

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