Spreadsheet: 3543f9ee-e5c4-4dae-b5cb-734a311dc0db
Sheet: FORMULIR

 | PERSATUAN GURU REPUBLIK INDONESIA (PGRI)
 | PENGURUS BESAR
 | FORMULIR REGISTRASI ANGGOTA PGRI
 | Isilah dengan [NAME] [NAME] dengan [NAME] sebenarnya
 | KETERANGAN PRIBADI
 |  | NPA PGRI |  |  |  |  |  |  | : | Prop-Kab/Kot-Kec-Anggota |  |  |  |  |  |  |  |  |  |  |  | :
 | 1. | [NAME] |  |  |  |  |  |  | :
 | 2. | [NAME]) |  |  |  |  |  |  | : | 1 | Laki-Laki |  |  |  |  |  |  |  | 2 | Perempuan
 | 3. | Tempat/[NAME] |  |  |  |  |  |  | : | ……………………………………………………
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Tgl |  |  | [NAME] |  |  | [NAME]
 | 4. | [NAME]) |  |  |  |  |  |  | : | 1 | Islam |  |  | 2 | Kristen |  |  |  | 3 | Katholik |  |  |  | 4 | Hindu |  |  | 5 | Budha
 |  |  |  |  |  |  |  |  |  | 6 | Khong Huchu |  |  |  |  |  |  |  | 7 | Kepercayaan Tuhan YME
 | 5. | Alamat |  |  |  |  |  |  | : | …………………………………………………… |  |  |  |  |  |  |  |  | RT:..... |  |  | RW:.... |  |  | Desa/Kel:...................
 |  |  |  |  |  |  |  |  |  | [NAME] :…………………….………… Kab/Kota : ………..………………..
 |  |  |  |  |  |  |  |  |  | Propinsi :........................................................................
 | 6. | [NAME] |  |  |  |  |  |  | :
 | 7. | No. Telepon |  |  |  |  |  |  | :
 | 8. | No. HP |  |  |  |  |  |  | :
 | 9. | Ijazah *) |  |  |  |  |  |  | : | 0 | SMA |  |  |  |  | 1 | D-1 |  |  |  |  | 2 | D-2 |  |  |  | 3 | D-3
 |  |  |  |  |  |  |  |  |  | 4 | S-1 |  |  |  |  | 5 | S-2 |  |  |  |  | 6 | S-3 |  |  |  | 7 | TIDAK DIKETAHUI
 | [NAME]
 | 10. | [NAME] |  |  |  |  |  |  | : | ………………………………………………………………………………………………………
 | 11. | Tugas *) |  |  |  |  |  |  | : | 1 | Kepala Sekolah |  |  |  |  |  |  |  |  |  |  | 2 | Wakil Kepala Sekolah
 |  |  | 3 | Kepala TU |  |  |  |  |  | 4 | Guru |  |  |  |  |  |  |  |  |  |  | 5 | Staf TU
 |  |  | 6 | Bendahara |  |  |  |  |  | 7 | Laboran |  |  |  |  |  |  |  |  |  |  | 8 | Pustakawan
 |  |  | 9 | Pengawas Sekolah |  |  |  |  |  | 10 | Pesuruh/Penjaga Sekolah |  |  |  |  |  |  |  |  |  |  | 11 | [NAME]
 |  |  | 12 | Petugas Instalsi |  |  |  |  |  | 13 | Tutor Keaksaraan |  |  |  |  |  |  |  |  |  |  | 14 | Pamong Belajar
 |  |  | 15 | TLD |  |  |  |  |  | 16 | Pengelola PKBM |  |  |  |  |  |  |  |  |  |  | 17 | Pendidik PAUD
 |  |  | 18 | Penilik |  |  |  |  |  | 19 | Instruktur Kursus |  |  |  |  |  |  |  |  |  |  | 20 | Tutor Paket A
 |  |  | 21 | Tutor Paket B |  |  |  |  |  | 22 | Tutor Paket C |  |  |  |  |  |  |  |  |  |  | 23 | [NAME]
 |  |  | 24 | Dosen |  |  |  |  |  | 25 | Pensiunan
 | 12. | [NAME] |  |  |  |  |  |  | :
 |  |  |  |  |  |  |  |  |  | Tgl |  |  | [NAME] |  |  | [NAME]
 | 13. | Status PNS *) |  |  |  |  |  |  | : | 0 | Non PNS |  |  |  |  | 1 | PNS |  |  |  |  | 2 | CPNS
 | 14. | Golongan *) |  |  |  |  |  |  | : | 1 | II-A |  |  |  |  | 2 | II-B |  |  |  |  | 3 | II-C |  |  |  | 4 | II-D
 |  |  |  |  |  |  |  |  |  | 5 | III-A |  |  |  |  | 6 | III-B |  |  |  |  | 7 | III-C |  |  |  | 8 | III-D
 |  |  |  |  |  |  |  |  |  | 9 | IV-A |  |  |  |  | 10 | IV-B |  |  |  |  | 11 | IV-C |  |  |  | 12 | IV-D
 |  |  |  |  |  |  |  |  |  | 13 | IV-E |  |  |  |  | 14 | NON PNS
 | 15. | [NAME] |  |  |  |  |  |  | : | 0 | TK |  |  |  |  | 2 | SMP |  |  |  |  | 4 | D-1 |  |  |  | 6 | D-3 |  |  |  | 8 | S-2
 |  | Tempat Mengajar *)
 |  |  |  |  |  |  |  |  |  | 1 | SD |  |  |  |  | 3 | SMA |  |  |  |  | 5 | D-2 |  |  |  | 7 | S-1 |  |  |  | 9 | S-3
 | 16. | Status Sekolah *) |  |  |  |  |  |  | : | 1 | Negeri |  |  |  |  | 2 | Swasta
 | 17. | Mengajar / Bidang Studi |  |  |  |  |  |  | : | …………………………………………………………………….
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | ………………………, ……………………………………
 |  | Foto |  |  |  |  | Foto |  |  |  |  |  |  |  |  |  | [NAME],
 |  | 4 x 6 |  |  |  |  | 4 x 6
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | …………………………………………
Catatan : |  | *) | Beri tanda Silang [ X ] pada [NAME] tersedia;