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Formulir Pendaftaran Pelatihan Online 2021 BPPTIK

Data Kegiatan Pelatihan
(This question is mandatory)
Pilih salah satu kegiatan Pelatihan Teknis dan Sertifikasi Bidang TIK yang ingin anda ikuti
(This question is mandatory)
Jadwal Pelatihan
Data Pribadi
(This question is mandatory)
Status Kepegawaian
(This question is mandatory)
Nama Lengkap
Tuliskan nama lengkap dan gelar lengkap anda (untuk penulisan di sertifikat)
(This question is mandatory)
Tempat Lahir
(This question is mandatory)
Tanggal Lahir
Open the date time chooser

Format: dd.mm.yyyy

(This question is mandatory)
Jenis Kelamin
(This question is mandatory)
Agama
(This question is mandatory)
Provinsi
(This question is mandatory)
No Handphone

format inputan: 0812-7922-1166

(mohon disesuaikan agar kami dapat langsung menghubungi Anda)

(This question is mandatory)
Email

contoh : bpptik@kominfo.go.id

(mohon disesuaikan agar kami dapat langsung menghubungi email Anda)

Data Pendidikan dan Pekerjaan
(This question is mandatory)
Jenjang pendidikan
(This question is mandatory)
Jurusan Pendidikan
(This question is mandatory)
Golongan Ruang/Pangkat
(This question is mandatory)
Jabatan
Data Instansi
(This question is mandatory)
Ruang Lingkup
(This question is mandatory)
Nama Instansi
(This question is mandatory)
Satuan Kerja
(This question is mandatory)
Alamat Kantor
(This question is mandatory)
Provinsi
(This question is mandatory)
Nomor Telepon Kantor

format inputan: (Kode_Area) - no_telp_kantor

(Harap diisi dengan kode area)

(This question is mandatory)
Email Kantor
Upload Dokumen
Upload Pas Foto

[tunggu sampai proses upload selesai]

Pas Foto berlatar belakang merah berlatar belakang merah

Laki-laki: kemeja putih, lengan panjang berdasi

Perempuan: kemeja/blouse putih lengan panjang. jilbab warna putih (bagi yang memekai jilbab)

Ukuran file max : 5 MB

File type : .jpg / .png

KTP

[tunggu sampai proses upload selesai]

Ukuran file max : 5 MB

(This question is mandatory)
Dengan ini saya menyatakan bahwa data yang saya berikan diatas adalah benar
Exit and clear survey