biodata calon guru malaysia 2016

BIODATA CALON GURU
UNTUK PENDIDIKAN ANAK-ANAK INDONESIA DI MALAYSIA/FILIPINA
PERIODE TAHUN 2016 – 2018

1. Nama (+gelar)

: .......................................................................................................................................................

2. NIP.

: ………...........................................................................................................................................

3. Agama

: .....................................................................................................................................................

4. No. Paspor

: .....................................................................................................................................................

5. Jenis Kelamin

: Laki-Laki

6. Tempat/Tgl. Lahir

: .......................................................................................................................................................

6. Guruan Terakhir

: .................................. Jurusan : . ............................................................................................

Perempuan

7. Alamat Rumah/Surat :
Jalan

: ..........................................................No.................Rt/Rw ......................................................
Kelurahan

:

.......................................................Kec. ......................................................................................

Kota/Kab

: ......................................................................................................................................................
Propinsi

: .....................................................................................................................................................
Kode Pos

: ................................Telp. ..............................................................................

No. HP

: .........................................................................................................................

email

: ........................................................................................................................

8.Keluarga yang dapat dihubungi :
a. Nama
b. Alamat

: …………………..................................................……………………….......................
: ..………………................................................…………………………......................

c. Hubungan Keluarga : ……………………………………………………..……….…………………..................
d. Nomor telepon/HP : ………………………………………………………………………………….................
9. Mendaftar pada LPTK : ......................................................................................................................
10. NO. NPWP

: ......................................................................................................................
Makassar,

2016

(……………………………….)