DATA VAKSINASI COVID-19 PEGAWAI DAN KELUARGA SMPN 104

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DATA VAKSINASI COVID-19 PEGAWAI DAN KELUARGA SMPN 104

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* Indicates required question

NAMA LENGKAP *

Your answer

STATUS PEGAWAI *

PNS

NON PNS

INSTANSI *

SMP Negeri 104

Required

NIP / NIKKI *

Honor ketik angka 0

Your answer

NIK *

Your answer

JABATAN *

Choose

KEPALA SEKOLAH

KASATLAK

GURU

TENAGA ADMINISTRASI

PERPUSTAKAAN

KEBERSIHAN

KEAMANAN

ALAMAT RUMAH *

Your answer

LOKASI VAKSIN 1 *

Your answer

TANGGAL VAKSIN 1

MM

/

DD

/

YYYY

LOKASI VAKSIN 2

Your answer

TANGGAL VAKSIN 2

MM

/

DD

/

YYYY

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