STIA BINA MANDIRI PARIAMAN
FORMULIR PENDAFTARAN ONLINE STIA BNM PARIAMAN
DATA PRIBADI
Nama *
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NIP/NIK *
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Tanggal Lahir *
MM
/
DD
/
YYYY
Tempat Lahir *
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Jenis Kelamin *
Agama *
Alamat Sesuai Identitas *
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Alamat Sekarang
TIDAK WAJIB DIISI APABILA SAMA DENGAN IDENTITAS
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Nomor Handphone
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DATA PENDIDIKAN
Pendidikan Terakhir *
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Asal Sekolah *
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Jurusan *
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Tahun Lulus *
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DATA PEKERJAAN
HANYA DIISI APABILA SUDAH BEKERJA
Instansi
Unit Kerja
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Jabatan
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Alamat Unit Kerja
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