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FORMULIR PANDAFTARAN
RELAWAN NU UNTUK PENDAMPING PEMBERDAYAAN MASYARAKAT DESA
I. Nama, Lokasi, Asal Calon Relawan
1. Ranting NU : KONTUKOWUNA
2. MWC NU : Kec. Kontukowuna
3. PCNU : Muna
4. PWNU : Sulawesi Tenggara
II. Nama dan Identitas Calon Relawan
1. Nama : LA SIFADI, S.Pdi
2. Jenis Kelamin : Laki-laki
3. Tempat Lahir : Larobay
4. Tanggal /Bulan/ Tahun lahir : 06 November 1987
5. Alamat : Desa Kontukowuna
6. Nomor HP : 085342864895
III. Status Perkawinan
Belum kawin
IV. Riwayat Pendidikan
No. Jenjang Nama Sekolah Status Tahun
1. SD SDN 3 Holo Tamat 2003
2. MTS MTS.S Karo Lembo Tamat 2005
3. MAN MAN Kota Baru Tamat 2008
4. Perguruan Tinggi STAIS SYARIF
MUHAMMAD RAHA
Tamat 2013
V. Pekerjaan Sekarang : Tidak ada
VI. Jabatan di Organisasi NU
No. Nama Jabatan Nama Organisasi Tahun
1.
2.
3.
VII. Pengalaman Kerja
No. Nama Pekerjaan Tahun
1.
2.
Penyulu Agama
Tehnisi Staf Sekretariat Panwaslu
Kab. Muna
2010
2013-2014
VIII.Pengalaman Organisasi di luar NU
No. Jabatan Nama Organisasi Tahun
1. Anggota PMII 2008
Mengetahui
MWC Kecamatan ................... Peserta Seleksi
(...................................) (LA SIFADI, S.Pdi)

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Formulir pandaftaran

  • 1. FORMULIR PANDAFTARAN RELAWAN NU UNTUK PENDAMPING PEMBERDAYAAN MASYARAKAT DESA I. Nama, Lokasi, Asal Calon Relawan 1. Ranting NU : KONTUKOWUNA 2. MWC NU : Kec. Kontukowuna 3. PCNU : Muna 4. PWNU : Sulawesi Tenggara II. Nama dan Identitas Calon Relawan 1. Nama : LA SIFADI, S.Pdi 2. Jenis Kelamin : Laki-laki 3. Tempat Lahir : Larobay 4. Tanggal /Bulan/ Tahun lahir : 06 November 1987 5. Alamat : Desa Kontukowuna 6. Nomor HP : 085342864895 III. Status Perkawinan Belum kawin IV. Riwayat Pendidikan No. Jenjang Nama Sekolah Status Tahun 1. SD SDN 3 Holo Tamat 2003 2. MTS MTS.S Karo Lembo Tamat 2005 3. MAN MAN Kota Baru Tamat 2008 4. Perguruan Tinggi STAIS SYARIF MUHAMMAD RAHA Tamat 2013 V. Pekerjaan Sekarang : Tidak ada VI. Jabatan di Organisasi NU No. Nama Jabatan Nama Organisasi Tahun 1. 2. 3. VII. Pengalaman Kerja No. Nama Pekerjaan Tahun 1. 2. Penyulu Agama Tehnisi Staf Sekretariat Panwaslu Kab. Muna 2010 2013-2014
  • 2. VIII.Pengalaman Organisasi di luar NU No. Jabatan Nama Organisasi Tahun 1. Anggota PMII 2008 Mengetahui MWC Kecamatan ................... Peserta Seleksi (...................................) (LA SIFADI, S.Pdi)