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Identitas Peserta (Opsional)

Nama Lengkap dengan Gelar

Jenis Pelatihan yang dipilih

Pelatihan Reguler Pelatihan di Wilayah Kerja Pelatihan di Tempat Kerja Pelatihan Jarak Jauh Pelatihan Kerjasama Short Course Pelatihan Dasar (Latsar) Orientasi PPPK

NIP/ NI PPPK (jika ada)

Jenis Kelamin

Choose... Laki-laki Perempuan

Tempat Lahir

Pangkat/Golongan

- Non PNS Pengatur Muda - II/a V Pengatur Muda Tk. I - II/b VI Pengatur - II/c VII Pengatur Tk. I - II/d VIII Penata Muda - III/a IX Penata Muda Tk. I - III/b X Penata - III/c XI Penata Tk. I - III/d XII Pembina - IV/a Pembina Tk. I - IV/b XIV Pembina Utama Muda - IV/c XV Pembina Utama Madya - IV/d XVI Pembina Utama - IV/e XVII Lainnya

Jabatan

Mata Pelajaran

- (Non Guru) Administrasi Akidah Akhlak Al-Qur'an Hadits Antropologi Bahasa Arab Bahasa Indonesia Bahasa Inggris Bahasa Jepang Bahasa Jerman Bimbingan Konseling Biologi Ekonomi Fikih Fisika Geografi Guru Kelas Guru RA Ilmu Pengetahuan Alam Ilmu Pengetahuan Sosial Keterampilan Kimia Matematika Muatan Lokal Agama Pendidikan Agama Budha Pendidikan Agama Hindu Pendidikan Agama Islam Pendidikan Agama Katolik Pendidikan Agama Kristen Pendidikan Kewarganegaraan Penjaskes Prakarya Sejarah Sejarah Kebudayaan Islam (SKI) Seni Budaya Seni Rupa Sosiologi Teknologi Informasi dan Komunikasi

Nama Instansi

Alamat Instansi Tempat Bekerja

Nama Kemenag Kota/Kab

Choose... Kantor Wilayah Kementerian Agama Prov. DI. Yogyakarta Kantor Wilayah Kementerian Agama Prov. Jawa Tengah Kantor Kementerian Agama Kab. Banjarnegara Kantor Kementerian Agama Kab. Bantul Kantor Kementerian Agama Kab. Banyumas Kantor Kementerian Agama Kab. Batang Kantor Kementerian Agama Kab. Blora Kantor Kementerian Agama Kab. Boyolali Kantor Kementerian Agama Kab. Brebes Kantor Kementerian Agama Kab. Cilacap Kantor Kementerian Agama Kab. Demak Kantor Kementerian Agama Kab. Grobogan Kantor Kementerian Agama Kab. Gunungkidul Kantor Kementerian Agama Kab. Jepara Kantor Kementerian Agama Kab. Karanganyar Kantor Kementerian Agama Kab. Kebumen Kantor Kementerian Agama Kab. Kendal Kantor Kementerian Agama Kab. Klaten Kantor Kementerian Agama Kab. Kudus Kantor Kementerian Agama Kab. Kulonprogo Kantor Kementerian Agama Kab. Magelang Kantor Kementerian Agama Kab. Pati Kantor Kementerian Agama Kab. Pekalongan Kantor Kementerian Agama Kab. Pemalang Kantor Kementerian Agama Kab. Purbalingga Kantor Kementerian Agama Kab. Purworejo Kantor Kementerian Agama Kab. Rembang Kantor Kementerian Agama Kab. Semarang Kantor Kementerian Agama Kab. Sleman Kantor Kementerian Agama Kab. Sragen Kantor Kementerian Agama Kab. Sukoharjo Kantor Kementerian Agama Kab. Tegal Kantor Kementerian Agama Kab. Temanggung Kantor Kementerian Agama Kab. Wonogiri Kantor Kementerian Agama Kab. Wonosobo Kantor Kementerian Agama Kota Magelang Kantor Kementerian Agama Kota Pekalongan Kantor Kementerian Agama Kota Salatiga Kantor Kementerian Agama Kota Semarang Kantor Kementerian Agama Kota Surakarta Kantor Kementerian Agama Kota Tegal Kantor Kementerian Agama Kota Yogyakarta Balai Diklat Keagamaan Semarang Balai Litbang Semarang UIN Sunan Kalijaga Yogyakarta UIN Walisongo Semarang IAIN Salatiga IAIN Purwokerto IAIN Surakarta IAIN Pekalongan IAIN Kudus STABN Wonogiri

No HP aktif (untuk komunikasi WA)

Alamat Rumah

Pendidikan Terakhir

SLTP/MTs SLTA/MA/SMK D.I D.II D.III S1 S2 S3

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