Biodata Peserta
6
PANITIA LOMBA KOMPETENSI SISWA (LKS) SMK XX TINGKAT PROPINSI JAWA TIMUR TAHUN 2012 SMK NEGERI 1 MAGETAN Jl. Kartini No. 06 Magetan 63314 (0351) 895094 Fax.(0351) 895094 Website : http://www. smkn1-magetan.sch.id Email : [email protected] BIDANG LOMBA : ..................................................... 1. Nama Peserta : ........................................................................ 2. Jenis Kelamin : Laki-laki / Perempuan *) 3. NIS : ............................................. ........................... 4. Tempat/Tanggal Lahir : ........................................................................ 5. Agama : ............................................. ........................... 6. Program Keahlian : ................................................. Kelas ............. 7. Asal Sekolah : SMK ................................................................. 8. Alamat Sekolah : Jl. .................................................................... ............................................. ........................... .............................. .......................................... Tlp. (.......) .................. Fax. (.......) .................. 9. Alamat Rumah : Jl. .................................................................... ............................................. ...........................
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Transcript of Biodata Peserta
Pas Photo3 X 4
PANITIALOMBA KOMPETENSI SISWA (LKS) SMK XX
TINGKAT PROPINSI JAWA TIMUR TAHUN 2012
SMK NEGERI 1 MAGETANJl. Kartini No. 06 Magetan 63314 (0351) 895094 Fax.(0351) 895094
Website : http://www. smkn1-magetan.sch.id Email : [email protected]
BIDANG LOMBA : .....................................................
1. Nama Peserta : ........................................................................
2. Jenis Kelamin : Laki-laki / Perempuan *)
3. NIS : ........................................................................
4. Tempat/Tanggal Lahir : ........................................................................
5. Agama : ........................................................................
6. Program Keahlian : ................................................. Kelas .............
7. Asal Sekolah : SMK .................................................................
8. Alamat Sekolah : Jl. ....................................................................
........................................................................
........................................................................
Tlp. (.......) .................. Fax. (.......) ..................
9. Alamat Rumah : Jl. ....................................................................
........................................................................
Kab./Kota*) ......................................................
Provinsi ...........................................................
Telp. (.........) .........................., .......................
HP. ........................................................
Mengetahui; ....................., .................... 2012
Kepala Sekolah
SMK ............................................ Peserta,
....................................... ...................................
NIP.
Catatan : - Diisi dengan huruf capital/diketik
- Hanya menyertakan foto copy raport
- Peserta bukan pemenang LKS 2011
- *) coret yang tidak perlu
Pas Photo3 X 4
PANITIALOMBA KOMPETENSI SISWA (LKS) SMK XX
TINGKAT PROPINSI JAWA TIMUR TAHUN 2012
SMK NEGERI 1 MAGETANJl. Kartini No. 06 Magetan 63314 (0351) 895094 Fax.(0351) 895094
Website : http://www. smkn1-magetan.sch.id Email : [email protected]
BIDANG LOMBA : .....................................................
1. Nama (Lengkap dengan gelar) : ........................................................................
2. Jenis Kelamin : Laki-laki / Perempuan *)
3. NIP : ........................................................................
4. Tempat/Tanggal Lahir : ........................................................................
5. Agama : ........................................................................
6. Jabatan Dinas : ........................................................................
7. Unit Kerja : SMK .................................................................
8. Alamat Unit Kerja : Jl. ....................................................................
........................................................................
........................................................................
........................................................................
Tlp. (.......) .................. Fax. (.......) ..................
Alamat Rumah : Jl. ....................................................................
........................................................................
Kab./Kota*) ......................................................
Provinsi ...........................................................
Telp. (.........) .........................., .......................
HP. ........................................................
Mengetahui; ....................., .................... 2012
Kepala Sekolah
SMK ............................................ Pembimbing,
....................................... ...................................
NIP.
Catatan : - Diisi dengan huruf kapital/diketik
- *) coret yang tidak perlu
Pas Photo3 X 4
PANITIALOMBA KOMPETENSI SISWA (LKS) SMK XX
TINGKAT PROPINSI JAWA TIMUR TAHUN 2012
SMK NEGERI 1 MAGETANJl. Kartini No. 06 Magetan 63314 (0351) 895094 Fax.(0351) 895094
Website : http://www. smkn1-magetan.sch.id Email : [email protected]
KABUPATEN/KOTA : .....................................................
1. Nama (Lengkap dengan gelar) : ........................................................................
2. Jenis Kelamin : Laki-laki / Perempuan *)
3. NIP : ........................................................................
4. Tempat/Tanggal Lahir : ........................................................................
5. Agama : ........................................................................
6. Jabatan Dinas : ........................................................................
7. Unit Kerja : ………................................................................
8. Alamat Unit Kerja : Jl. ....................................................................
........................................................................
........................................................................
........................................................................
Tlp. (.......) .................. Fax. (.......) ..................
Alamat Rumah : Jl. ....................................................................
........................................................................
Kab./Kota*) ......................................................
Provinsi ...........................................................
Telp. (.........) .........................., .......................
HP. ........................................................
....................., .................... 2012
Ketua Kontingen,
...................................
NIP.
Catatan : - Diisi dengan huruf kapital/diketik
- *) coret yang tidak perlu
