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  • Daftar Isian Track Record Assessment: ( Coret Yg Tidak Perlu)

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    riyu
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    This document contains a form with sections for personal details, career history, education history, assessments, awards, and family history of an employee named Rina Febriana. It includes information such as her date of birth, religion, education qualifications, job positions held, training attended, published works, and details of her parents, spouse, and siblings. The purpose of the document is to provide a record of her track record and background for assessment purposes.

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    TRACK RECORD ASSESMENT

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    TrackRecordAssessment.doc

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    This document contains a form with sections for personal details, career history, education history, assessments, awards, and family history of an employee named Rina Febriana. It includes information such as her date of birth, religion, education qualifications, job positions held, training attended, published works, and details of her parents, spouse, and siblings. The purpose of the document is to provide a record of her track record and background for assessment purposes.

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    © All Rights Reserved
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    44 views4 pages

    Daftar Isian Track Record Assessment: ( Coret Yg Tidak Perlu)

    Uploaded by

    riyu
    This document contains a form with sections for personal details, career history, education history, assessments, awards, and family history of an employee named Rina Febriana. It includes information such as her date of birth, religion, education qualifications, job positions held, training attended, published works, and details of her parents, spouse, and siblings. The purpose of the document is to provide a record of her track record and background for assessment purposes.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 4

    Poto 3x4 berwarna

    DAFTAR ISIAN
    TRACK RECORD ASSESSMENT

    A. IDENTITAS PEGAWAI

    1. Nama : Rina Febriana


    2. NIP/NIPK :
    3. Tempat/Tgl lahir (Usia) : Tangerang, 4 Februari 1994 (23th)
    4. Jenis Profesi : Asisten Apoteker
    5. Jenis Kelamin : Perempuan
    6. Agama : * islam/ protestan/ katolik/ hindu/ budha
    (*coret yg tidak perlu)
    7. Jenis Kepegawaian : (PNS/CPNS/PTT/Kontrak /Kontrak BLUD
    8. Alamat Rumah : Perumahan Taman Fasco blok A8 no 6,
    Tangerang Selatan
    9. Pangkat Terakhir :
    10. Masa kerja Golongan :
    11. Jabatan :
    12. Instansi Tempat Bekerja :
    13. Unit Kerja :

    B. RIWAYAT KEPANGKATAN

    NO PANGKAT GOLONGAN/ TMT SURAT KEPUTUSAN PEJABAT


    RUANG NOMOR TANGGAL yang
    MENETAPKAN
    1
    2
    3

    C. RIWAYAT FUNGSIONAL TERTENTU

    NO SK. PENGAKATAN TMT SURAT KEPUTUSAN PEJABAT NILAI


    TERKAIT JFT NOMOR TANGGAL yang PAK
    MENETAPKAN
    1
    2
    3

    1
    D. RIWAYAT PENDIDIKAN

    1. Pendidikan Umum

    JENJANG NAMA KEPSEK/


    NAMA SEKOLAH/ STTB/IJAZAH
    dan DIREKTUR/ KATEGORI
    NO AKADEMI/
    JURUSAN DEKAN/KETUA/ NILAI
    PT
    PENDIDIKAN REKTOR NOMOR TANGGAL
    1 IPA SMAN 3 Drs. H. Sujana, M.Pd DN-30 Ma 26 Mei
    Tangerang 0008765 2012 8,0
    Selatan
    2 S1 FARMASI UNIV.PANCASIL Prof.Dr.Shirly 200195/S1/UP/ 28 Juli
    A Kumala, M.biomed., 2016 2016 2,84
    Apt.
    3
    4
    5

    2. Pendidikan dan Pelatihan Kepemimpinan (DIKLATPIM)

    TEMPAT DAN STTPP


    NAMA DIKLAT ANGKATAN LAMA STTPP
    NO STRUKTURAL
    PENYELENGGARA / TAHUN TGL NILAI
    DIKLAT
    PENDIDIKAN NOMOR

    3. Pendidikan dan Pelatihan Fungsional

    TEMPAT dan STTPP


    NO NAMA DIKLAT PENYELENGGARA
    ANGKATAN/ LAMA
    TAHUN PENDIDIKAN NOMOR TANGGAL
    DIKLAT
    1

    4. Pendidikan dan Pelatihan Teknis atau Pelatihan Lain

    TEMPAT dan STTPP


    NO NAMA DIKLAT PENYELENGGARA
    ANGKATAN LAMA
    /TAHUN PENDIDIKAN
    DIKLAT NOMOR TANGGAL
    1
    2
    3

    2
    E. DP-3 dan SKP

    NO TAHUN PEJABAT PENILAI ATASAN PEJABAT PENILAI NILAI

    1
    2
    3

    F. PENGALAMAN DIKLAT DAN ATAU SEMINAR DAN ATAU WORK SHOP


    DALAM NEGERI / LUAR NEGERI MENGENAI SUATU BIDANG ILMU /
    PEMERINTAHAN / KEPROFESIAN

    TEMPAT dan ANGKATAN/ STTPP


    LAMA
    NO NAMA DIKLAT PENYELENGGARA
    TAHUN PENDIDIKAN
    DIKLAT NOMOR TANGGAL
    1

    G. PENGALAMAN BERKARYA PADA BIDANG TUGAS PEMERINTAHAN /


    KEILMUAN / KEPROFESIAN

    NO. KEGIATAN URAIAN TAHUN


    1. Lomba Karya Tulis Ilmiah Fakultas LKTI FF-UP yang diikuti bertema 2014
    Farmasi Universitas Pancasila “Inovasi penggunaan bahan alam
    sebagai Sediaan obat”
    2.
    3.
    4.

    H. RIWAYAT PENGHARGAAN

    NAMA
    SURAT KEPUTUSAN PENYELENGGARA
    PENGHARGAAN
    NO
    JABATAN
    NOMOR TGL INSTANSI LOKASI
    PENANDATANGAN
    1 7 peserta karya tulis 33/S/LKTI 21 DEKAN FAKULTAS UNIVERSIT JAKARTA
    ilmiah terbaik /BID I/ JUNI FARMASI AS SELATAN
    SEMA 2014 UNIVERITAS
    FF- PANCASILA
    KMUP/VI.
    2014

    3
    I. RIWAYAT KELUARGA

    JEN
    IS TGL
    TEMPAT PENDIDIK STATUS
    NO RIWAYAT NAMA KEL NIK PEKERJAAN
    TGL LAHIR AN PERKAWAINAN
    AMI AH
    N
    1 SUAMI/ISTRI
    2 ANAK

    3 ORANG TUA Tatang Lak Bandung, S1 Pensiunan Kawin


    Priatna i- 4 Mei pns
    laki1957
    Komariah Per Bandung, SMK IRT Kawin
    em 14
    pua Agustus
    n 1958
    4 SAUDARA Angga Lak Bandung, S1 Karyawan Kawin
    Gautama i- 12 Apoteker BUMN
    lakiSeptembe
    r 1984
    Winda Per Bandung, S1 Karyawati Lajang
    Meliana em 9 Juli Psikologi swasta
    pua 1988
    n
    Dessi Per Tangeran S1 Tata Mahasiswi Lajang
    Rianasari em g, 14 Boga
    pua Agustus
    n 1995

    Bandung, ……………… 2017

    Nama lengkap
    NIP……………….

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