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KEMENTERIAN AGAMA REPUBLIK INDONESIA INSTITUT AGAMA ISLAM NEGERI (IAIN) KENDARI Jl. Sultan Qaimuddin No. 17, Telp (0401) 3192081 Fax (0401) 3193710 Email [email protected] Website http://iainkendari.ac.id |
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FORMULIR DAFTAR RIWAYAT HIDUP PEGAWAI NEGERI SIPIL
I. Data Utama
| 1. | NIP Baru | : | 198002272005012006 |
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| NIP Lama | : | |||
| 2. | Nama Lengkap | : | Dr. Hj. Imelda Wahyuni, S.S., M.Pd.I. | |
| 3. | Tempat/ Tanggal Lahir | : | BARANTI/ XXXXXXXXXX | |
| 4. | Kelamin | : | P | |
| 5. | Agama | : | ISLAM | |
| 6. | Status Perkawinan | : | XXXXX | |
| 7. | Status Kepegawaian | : | XXXXXXX | |
| 8. | Pangkat | : | XXXXXXXXXXXXXXXXXXXXXXXXX | |
| 9. | Jabatan Akhir | : | XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX | |
| 10. | Pendidikan Akhir | : | S3, Universitas Alauddin Makassar Tahun 2014 | |
| 11. | Satuan Kerja | : | XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX | |
| 12. | Satuan Organisasi | : | XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX | |
| 13. | KGB Terakhir | : | XXXXXXXXXX | |
| 14. | Matakuliah Diampu | : | Pendidikan Bahasa Arab | |
| 15. | Akta | : | Tidak Ada | |
| 16. | Nomor Kepegawaian | |||
| a. KARPEG | : | XXXXXXXXX | ||
| b. KTP | : | XXXXXXXXXXXXXXXX | ||
| c. KARIS/SU | : | |||
| d. KPE | : | XXXXXXXXXXXXXXXXX | ||
| e. TASPEN | : | XXXXXXXXX | ||
| f. NPWP | : | XXXXXXXXXXXXXXXXXXXX | ||
| g. NO. FUNGSIONAL | : | XXXXXXXXXXXX | ||
| h. NIDN | : | XXXXXXXXXX | ||
| i. NIRA | : | XXXXXXXXXXXXXXXXXXXX | ||
| i. BPJS/ ASKES | : | XXXXXXXXXXXXX | ||
| j. No. Kartu Keluarga | : | XXXXXXXXXXXXXXXX | ||
| k. No. Akta Lahir | : | XXXXXXXXXXXXXXXXX | ||
| l. No. Surat Nikah | : | XXXXXXXXXX | ||
| 17. | Alamat Rumah | |||
| a. Jalan | : | XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX | ||
| b. Kelurahan/ Desa | : | XXXXXXXXXX | ||
| c. Kecamatan | : | XXXXXX | ||
| d. Kabupaten/ Kota | : | XXXXXXX | ||
| e. Provinisi | : | XXXXXXXXXXXXXXXXX | ||
| f. No. Telepon/ HP | : | XXXXXXXXXXXX | ||
| g. Email | : | XXXXXXXXXXXXXXXXXXXXXXXXX | ||
| 18. | Keterangan Badan | |||
| a. Tinggi Badan (cm) | : | XXXXXX | ||
| b. Berat Badan (Kg) | : | XXXXX | ||
| c. Rambut | : | XXXXX | ||
| d. Bentuk Muka | : | XXXX | ||
| e. Warna Kulit | : | XXXXXXXXXXX | ||
| f. Ciri-ciri Khas | : | XXXXXXXXXXX | ||
| g. Cacat Tubuh | : | X | ||
| 19. | Kegemaran/ Hobby | : | XXXXXXX | |