Daftar Riwayat Hidup Curiculum Vitae

DAFTAR RIWAYAT HIDUP

Yang bertanda tangan di bawah ini :

1.       Nama                                     :                                                                                      

2.       Tempat, Tanggal Lahir           :                                                                                      

3.       Agama                                   :                                                                                      

4.       Kebangsaan                           :                                                                                      

5.       Status                                     :                                                                                      

6.       Alamat                                   :                                                                                      

                                                                                                                                              

7.       Pendidikan                             :                                                                                      

-          SD                                    :                                                                                      

-          SMP                                 :                                                                                      

-          SMA                                :                                                                                      

-          Perguruan Tinggi             :                                                                                           

8.       Nama Orang Tua                   : 

a. Ayah                                   :                                                                                      

b. Ibu                                      :                                                                                      

9.       Pekerjaan Orang Tua             :                                                                                      

10.   Alamat Orang Tua                 :                                                                                      

                                                                                                                                            

Demikian Daftar Riwayat Hidup kami buat dengan sesungguhnya atau sebenarnya, apabila kami memberikan keterangan palsu kami sanggup dituntut di muka hakim berdasarkan Undang-undang yang berlaku.

……………., …………………………….. Kami tersebut di atas, …………………………..