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Form Identitas Guru Sertifikasi Kosong

Form Identitas Guru Sertifikasi Kosong

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Published by Khoirullah Mukhlis

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Published by: Khoirullah Mukhlis on Apr 10, 2013
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04/30/2014

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Kuota Sertifikasi

.........................
FORM IDENTITAS UPDATE
GURU LULUS SERTIFIKASI
RA/MADRASAH/PAIS/WASPENDAIS
No!or KTP " .........................
# No!or Peserta " .........................
$ Na!a %&e'ar (i)e'aka*&+ " .........................
, Pe*(i(ika* Terak-ir. " SLTA / D / D# / D$ / S / S# / S$
/ NIP " .........................
0 NUPTK " .........................
1 2e*is ke'a!i* " .........................
3 Te!4at5 ta*&&a' 'a-ir " .........................5 .........................
6 Na!a I)u Ka*(u*& " .........................
7 Pa*&kat/Go' %PNS+ " .........................
TMT Pa*&kat/Go' %PNS+ " .........................
# TMT !e*8a(i Guru %PNS/S9asta+ " .........................
$ Ga8i Pokok %PNS+ :a*& !asi- )er'aku " R4. .........................
, Satker Ga8i %PNS+. " KEMENAG/MADRASAH NEGERI
/ RA/Ma(rasa- Pa*&ka' " .........................
A'a!at " .........................
Ke;a!ata* " .........................
0 Ra*&ka4a* Madrasah Lain " .........................
1 Tu&as/Ma4e' Pokok " .........................
3 Tu&as/Ma4e' Tambahan " .........................
6 Tu&as/Ma4e' Madrasah Lain " .........................
#7 2u!'a- 8a! 4e'a8ara* " Tu&as/Ma4e' Pokok " .........................2TM
Tu&as/Ma4e' Tambahan " .........................2TM
Tu&as/Ma4e' Mad Lain " .........................2TM
Tota' " .........................2TM
# Ma4e' sesuai Sertifikat " .........................
## No. Sertifikat " .........................
#$ Ta*&&a' TTD Sertifikat " .........................
#, NRG " .........................
#/ No!or SK Dir8e* " .........................
#0 Ta*&&a' SK Dir8e* " .........................
#1 No. Te'e4o* RA/Ma(rasa- " .........................
#3 No. Te'e4o*/HP :)s "
#6 Ketera*&a* Lai*. " AKTIF / NON AKTIF / MUTASI / PENSIUN / WAFAT
$7 Ma(rasa-/Seko'a- MUTASI " ..............................
De!ak5 <<<<<<..
Ke4a'a Guru
<<<<<<<<<<<<<. .........................
NIP. NIP. .........................
Ketera*&a* "
= Di'a!4iri Foto Ko4i KTP
= >oret )i'a Data ti(ak sesuai (a* )e*arka* (& Ti*ta Mera-
∗ >oret :& ti(ak 4er'u

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