SDN …………………………………. BUKU INDUK PEGAW AI NOMOR INDUK : ..... ........................... 1 Nama Pegawai : a. Lengkap : .......................................... b. Panggilan : .......................................... 2. eni! Kelamin : Laki – Laki / Perempuan " Kela#i$an : a. %anggal : .......................................... b. %e mpa& : .......................................... '. Agama : Islam ( Kewa$ganega$aan : WNI ) G*langan Da$a# : ....................... + aba&an : .......................................... ,. Pangka&-G*l*ngan-Rang : .......................................... a. Tanggungan Keluarga b. Y ang Masuk Daftar Gaji 1. ................................. 2. ................................. /. N*m*$ Pe&n0k Pegawai : a. KTP : ............................ b. Karpeg/NIP : ............................ c. Kartu Ta spen : ............................ d. Kartu Askes : ............................ e. Kartu Anggota PGI : ............................ f. Kartu Anggota Koperasi : ............................ g. No!or "K Angkatan : ............................ 1. Alama& an N* %elp : Ka!pung : ................................. t / # : ................................. Desa : ................................. Keca!atan : ................................. 11. Peniikan : a. "D %a#n Ll! :................ b. "MP %a#n Ll! :................ c. "$TA %a#n Ll! :................ d. DII %a#n Ll! :................ c. "%& %a#n Ll! :................ d. "%' %a#n Ll! :................ 12. Mlai Ma!k 3D Ini : 1". M&a!i : a. Pinda( Dari 3D :......................... Ke4 : ......................... %# n : ......................... b. Pinda( Ke 3D :......................... Ke4 : ......................... %# n : ......................... 1' La in 5Lai n - 6a &a &an 7a ng Pen&ing : .......................................................................... ..........................................................................

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BUKU INDUK PEGAWAI

SDN .BUKU INDUK PEGAWAI

NOMOR INDUK : ................................

1Nama Pegawai:a.Lengkap : ..........................................

b.Panggilan: ..........................................

2.Jenis Kelamin:Laki Laki / Perempuan

3Kelahiran:a. Tanggal: ..........................................

b. Tempat: ..........................................

4.Agama:Islam

5Kewarganegaraan:WNI

6Golangan Darah:.......................

7Jabatan:..........................................

8.Pangkat/Golongan/Ruang:..........................................

a. Tanggungan Keluarga

b. Yang Masuk Daftar Gaji

1. .................................

2. .................................

9.Nomor Petunjuk Pegawai:a. KTP: ............................

b. Karpeg/NIP: ............................

c. Kartu Taspen: ............................

d. Kartu Askes: ............................

e. Kartu Anggota PGRI: ............................

f. Kartu Anggota Koperasi: ............................

g. Nomor SK Angkatan: ............................

10.Alamat dan No Telp:Kampung: .................................

Rt / Rw: .................................

Desa: .................................

Kecamatan: .................................

11.Pendidikan:a. SDTahun Lulus:................

b. SMPTahun Lulus:................

c. SLTATahun Lulus:................

d. DIITahun Lulus:................

c. S-1Tahun Lulus:................

d. S-2Tahun Lulus:................

12.Mulai Masuk SD Ini:

13.Mutasi:a. Pindah DariSD:.........................

Kec:.........................

Thn:.........................

b. Pindah KeSD:.........................

Kec:.........................

Thn:.........................

14Lain -Lain / Catatan Yang Penting :....................................................................................................................................................

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