Format Spmt Cpns 2018.docx

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KOP SURAT UNIT KERJA

SURAT PERNYATAAN MELAKSANAKAN TUGAS Nomor : .......................................................

Yang bertanda tangan di bawah ini : 1. Nama

: .......................................................................................

2. NIP

: .......................................................................................

3. Pangkat/Gol. Ruang

: .......................................................................................

4. Jabatan

: .......................................................................................

a.

dengan ini menyatakan bahwa : 1. Nama

: .......................................................................................

2. NIP

: .......................................................................................

3. Gol. Ruang

: .......................................................................................

b.

4. Surat Keputusan pengangkatan sebagai Calon Pegawai Negeri Sipil : a. Pejabat yang mengangkat

: Bupati Tasikmalaya

b. Nomor

: 813/Kep.67-BKD/2019

c. Tanggal

: 18 Maret 2019

d. TMT CPNS

: 01 Maret 2019

telah secara nyata melaksanakan tugasnya sejak tanggal 01 April 2019. Demikian pernyataan ini dibuat dengan sesungguhnya, untuk dapat digunakan seperlunya.

Tasikmalaya, 01 April 2019 Yang membuat pernyataan, ……………………………….. a.4

................................................................. a.1 NIP ..............................................a.2

Keterangan : a. diisi dengan biodata pimpinan unit kerja; b. diisi dengan biodata CPNS;

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