formulir pendaftaran peserta sertifikasi bagi guru pai tahun 2016

Daftar Isi

Contoh formulir pendaftaran peserta sertifikasi bagi guru pai tahun 2016 - Berikut kami bagikan contoh formatnya, bagi yang membutuhkan bisa mengunduhnya melalui link dibawah.

1.      Nomor Peserta                                    :........................................................................................

2.      Nama Lengkap                                    :........................................................................................

3.      NUPTK                                               :........................................................................................

4.      Pola Sertifikasi                                    :........................................................................................

5.      Bidang Studi Sertifikasi                     :........................................................................................

6.      NIP                                                     :........................................................................................

7.      Pangkat/Golongan                              :.........................................................................................

8.      Masa Kerja Sebagai Guru                   :.................Tahun...............Bulan ..................................

9.      Jenis Kelamin                                      :........................................................................................

10.   Tempat Tanggal Lahir                        :........................................................................................

11.   Pendidikan Terakhir                           :........................................................................................

Nama Perguruan Tinggi                      :........................................................................................

 Tahun Lulus                                       :........................................................................................

12.  Jenjang Pendidikan Tempat Tugas     :........................................................................................

13.   Mata Pelajaran                                   :.........................................................................................

14.   Beban Kerja                                       :......................Jam Perminggu.........................................

15.   Tugas Tambahan                                :.........................................................................................

16.  Masa Kerja Sebaga Pengawas            :.........................................................................................

17.   Sekolah Tempat Tugas                                  

a.       Nama                                             :.........................................................................................

b.      Alamat                                          :.........................................................................................

c.       Kecamatan                                                :.........................................................................................

d.      Kabupaten Kota                            :..........................................................................................

e.       NPSN                                            :...........................................................................................

Mengetahui Kasi PAIS Kab. Garut Rd. Ahmad Hibban (Bey), S.Pd.I Nip. 196403021993031004

Mengetahui/Menyetujui Kepala Sekolah ...........................................

Guru/ Calon Peserta ...........................................

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