FORM PENDAFTARAN MAGANG 2 DAN 3

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FORM PENDAFTARAN MAGANG 2 DAN 3

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* Indicates required question

NIM (Tanpa Spasi. Contoh: A210140001) *

Your answer

NAMA (Ditulis lengkap)

Your answer

Tanggal lahir

MM

/

DD

/

YYYY

Alamat

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Agama (untuk keperluan distribusi tempat magang)

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Islam

Selain Islam

Jenis Kelamin

Laki-laki

Perempuan

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Jika Perempuan Muslimah

Bercadar

Tidak bercadar

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Nama dan Tanda Tangan

( ____________________________ )

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