FORMAT AK.5 PERMOHONAN BANDING.docx
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CONTOH PERMOHONAN BANDING ASESMEN KOMPETENSI Kepada Yth Tim Asesor Rumah Sakit Dengan ini saya mengajukan banding terhadap hasil asesmen dengan rincian sebagai berikut : Tanggal Penetapan : . . / / (Tanggal/Bulan/Tahun) Kompetensi yang kompeten/tidak kompeten (Tulis dengan huruf cetak) : .................................................................... .................................................................... .................................................................... .................................................................... .................................................................... Dasar pengajuan banding adalah : (Tulis dengan huruf cetak dan harap melampirkan bukti dokumen terkait) .................................................................... .................................................................... .................................................................... .................................................................... .................................................................... .................................................................... .................................................................... .................................................................... .................................................................... .................................................................... .................................................................... Demikian permohonan ini saya buat agar menjadi pertimbangan. ..../....../.... Pemohon FORM AK.5
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Transcript of FORMAT AK.5 PERMOHONAN BANDING.docx
CONTOH
PERMOHONAN BANDING ASESMEN KOMPETENSI
Kepada YthTim Asesor Rumah Sakit
Dengan ini saya mengajukan banding terhadap hasil asesmen dengan rincian sebagai berikut :
Tanggal Penetapan : .............. / ...... / ........ (Tanggal/Bulan/Tahun)
Kompetensi yang kompeten/tidak kompeten (Tulis dengan huruf cetak) :....................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................
Dasar pengajuan banding adalah :
(Tulis dengan huruf cetak dan harap melampirkan bukti dokumen terkait)............................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................
Demikian permohonan ini saya buat agar menjadi pertimbangan.
.........../................./...........Pemohon
(.......................................)
FORM AK.5
