formulir pendaftaran peserta sertifikasi bagi guru pai tahun 2016
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 :...........................................................................................
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Mengetahui
Kasi PAIS Kab. Garut
Rd. Ahmad Hibban (Bey), S.Pd.I
Nip. 196403021993031004
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Mengetahui/Menyetujui
Kepala Sekolah
...........................................
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Guru/ Calon Peserta
...........................................
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