Request edit access
JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Form Pemberkasan PTK Brighton JHS
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Mengisi baru / update?
Choose
Isi baru
Update
Nama Lengkap
*
Your answer
Gelar
(misalnya S.Pd, S.S, S.Sos, dll)
Your answer
NIK
*
Your answer
Jenis Kelamin
*
Choose
Laki-laki
Perempuan
Tempat Lahir
*
Your answer
Tanggal Lahir
*
MM
/
DD
/
YYYY
Nama Lengkap Ibu Kandung
*
Your answer
Nomor SK GTY
Mohon isi bila mengetahui.
Your answer
NIY
Your answer
Tanggal SK GTY
Mohon isi bila mengetahui.
MM
/
DD
/
YYYY
Tanggal Mulai Tugas (TMT)
silakan dilihat pada SK GTT
MM
/
DD
/
YYYY
Jenjang Pendidikan Terakhir
*
Choose
SMA/SMK
D3
D4
S1
S2
S3
Nama Instansi Pendidikan Terakhir
*
Your answer
NIS/NIM
Your answer
Jurusan/Program Studi
*
Your answer
Alamat Tempat Tinggal
*
Your answer
RT
*
Your answer
RW
*
Your answer
Dusun
Your answer
Desa/Kelurahan
*
Your answer
Kecamatan
*
Your answer
Kode Pos
*
Your answer
Agama
*
Choose
Islam
Kristen Protestan
Katholik
Hindu
Buddha
Konghuchu
Kepercayaan Tuhan YME
NPWP
Your answer
Nama Wajib Pajak
Your answer
Kewarganegaraan
*
Choose
WNI
WNA
Status Perkawinan
*
Kawin
Belum Kawin
Janda/Duda
Nama Suami / Istri
Your answer
NIP Suami/Istri
Your answer
Pekerjaan Suami/Istri
Choose
Tidak bekerja
Nelayan
Petani
Peternak
PNS/TNI/Polri
Karyawan Swasta
Pedagang Kecil
Pedagang Besar
Wiraswasta
Wirausaha
Buruh
Pensiunan
Sudah meninggal
Lain-lain
No. Telp Rumah/Suami/Istri
Your answer
No. HP
*
Your answer
Email
*
Your answer
ID Bank
*
Choose
BCA
Mandiri
BNI
BRI
BJB
Lainnya
No. Rekening
*
Your answer
Atas Nama
*
Your answer
Submit
Page 1 of 1
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. -
Terms of Service
-
Privacy Policy
Does this form look suspicious?
Report
Forms
Help and feedback
Contact form owner
Help Forms improve
Report
