Biodata Anggota

BIODATA ANGGOTA LEADHAM INTERNATIONAL

DPC / DPD :

KABUPATEN :

NO

NAMA

TEMPAT / TANGGAL LAHIR

JENIS KELAMIN

STATUS PERKAWINAN

JUMLAH ANGGOTA KELUARGA  (ISTRI/SUAMI + ANAK)

AGAMA

PENDIDIKAN TERAKHIR / JURUSAN

JABATAN

ALAMAT

PAS PHOTO

Kartu Tanda Anggota

KARTU TANDA ANGGOTA

No	IDENTITAS PENGURUS				PAS PHOTO
	Nama Lengkap		Tinggi Badan
	Tempat /Tanggal Lahir		Berat badan
	Jenis Kelamin		Gol. Darah
	Agama		Rambut
	Alamat		Mata
	Status		Uk. Baju
	Jabatan
	No. Reg. PBB
	No. HP

Daftar Riwayat Hidup

DAFTAR RIWAYAT HIDUP

Bahwa yang bertanda tangan dibaawah ini     :

                                Nama                                      : ........................................................................................................

                                Umur                                      : ...............................................

                                Tanggal Lahir                         : ...............................................

                                Bangsa                                    : ................................................                             

                                Agama                                    : ................................................

                                Tempat tinggal sekarang     : .........................................................................................................

Menerangkan denga sesungguhnya

                                                                                  P E N D I D I K A N

Tamatan .....................................................................................................................................................

..................................................................................................................................... Berijazah / tidak*)

2.       Tamatan .....................................................................................................................................................

..................................................................................................................................... Berijazah / tidak*)

3.       Tamatan .....................................................................................................................................................

..................................................................................................................................... Berijazah / tidak*)

4.       Pernah memasuki Fakultas / Akademi ......................................................................................................

...................................................... sampai tingkat persiapan / Sarjana Muda (B A) Doctoral / Sarjana *)

                                                    P E N G A L A M A N  B E K E R J A

1.       Dari tahun ...................................... s/d tahun ...........................................................................................

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

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

2.       Dari tahun ...................................... s/d tahun ...........................................................................................

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

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

3.       Dari tahun ...................................... s/d tahun ...........................................................................................

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

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

4.       Keterangan lain-lain ...................................................................................................................................

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

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

                                                                 Demikian daftar riwayat hidup ini saya buat dengan sebenarnya

                                                                                                                                              

                                                                                ……………............................,........,........,20…

                                                                                              Saya yang bersangkutan

                                                                               

                                                                                               

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