SURAT PERNYATAAN KESANGGUPAN

SURAT PERNYATAAN KESANGGUPAN
MENGIKUTI SELEKSI CALON PEJABAT STRUKTURAL
ESELON III DAN IV DI LINGKUNGAN UNIVERSITAS DIPONEGORO
TAHUN 2016
Yang bertanda tangan di bawah ini , saya :
Nama

:

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NIP

:

..............................................................................................

Pangkat / Golongan

:

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Pendidikan Terakhir

:

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Unit Kerja

:

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 Pengalaman jabatan Strktural / Pengalaman Kerja :
1. ......................................................................................................................................
2. ......................................................................................................................................
3. ......................................................................................................................................
4. ......................................................................................................................................
5. ......................................................................................................................................

6. ......................................................................................................................................
7. ......................................................................................................................................
8. ......................................................................................................................................
 Diklatpim / Diklat Teknis yang pernah diikuti :
1. ......................................................................................................................................
2. ......................................................................................................................................
3. ......................................................................................................................................
4. ......................................................................................................................................
5. ......................................................................................................................................
6. ......................................................................................................................................
7. ......................................................................................................................................
8. ......................................................................................................................................
Menyatakan sanggup untuk mengikuti Seleksi Calon Pejabat Struktural Eselon III / IV *) di
lingkunganm Universitas Diponegoro.
Apabila menduduki jabatan stuktural Eselon III / IV *), sanggup untuk mengikuti Diklatpim
sesuai peraturan kepegawaian yang berlaku.
Semarang,
Mengetahui Pimpinan Fak. / Unit
.....................................................

Yang menyatakan,

....................................................
NIP.

.................................................
NIP.

*) Coret yang tidak perlu.