Formulir Open R

  • April 2020
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FORMULIR PENDAFTARAN DIVISI COC (Center of Competency) IT SERVICE Pusat Komputer Masjid Fatimatuzzahra Jl. Gunung Muria Kelurahan Grendeng Purwokerto 53122

IDENTITAS UMUM Nama Lengkap Nama Panggilan Tempat / Tgl Lahir

………-……………………...- 19…..

Alamat Asal Kode Pos

Telepon 

Nama Kost Alamat Kost

Jl. Telepon 

NO Telp / HP Univ. / Fak. / Jur. Angkatan / NIM Anak ke - dari

Nim Ke

……………. Bersaudara

Hobby Misi Hidup Visi Hidup Keterampilan / keahlian khusus yang dimiliki / diminati Komputer**

Seni*

COC APLIKASI

COC OS

COC DATABASE

COC

COC

COC

HARDWARE

ELEKTRONIKA

NETWORK

Vokal

Olahraga* Organisasi*

Humor

Beladiri (……………….……) Leader

Lukis Turnamen

Tari / gerak tubuh Extreem

(……………..……….…..….) (………..……………………….....) Konseptor

Anggota

Purwokerto, ....................................20.......... Hormat saya,

(.................................)

Nb. * Beri tanda "√" Pilihan boleh lebih dari satu **Pilih salah satu

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