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KLINIK PRATAMA UWA MEDIKA

IZIN NO : 5/05.13/DPMPTSP/III/2019
Jl. H.R. Subrantas No. 92A, Kec Tampan-Pekanbaru
Telpon (0761) 7875833

BIODATA KARYAWAN
NAMA :…………………………………………………………………..

TEMPAT, TANGGAL LAHIR :…………………………………………………………………..

AGAMA :…………………………………………………………………..

ALAMAT :………………………………………………………………….

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NO HP :……………………………………………………………………..

PENDIDIKAN TERAKHIR :…………………………………………………………………….

PERGURUAN TINGGI :……………………………………………………………………..

MULAI KERJA :………………………………………………………………………

PEKANBARU, …………..20…

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