Minggu, 06 November 2011

Bahan Kuliah Adm. Perkantoran DP3








RAHASIA
DAFTAR PENILAIAN PELAKSANAAN PEKERJAAN
PEGAWAI NEGERI SIPIL


KEMENTERIAN PENDIDIKAN NASIONAL                                                           JANGKA WAKTU PENILAIAN
                                                                                                                  BULAN JANUARI s.d. DESEMBER 2010
1
YANG DINILAI

a. N a m a


b. N I P


c. Pangkat, Golongan Ruang


d. Jabatan / Pekerjaan


e. Unit Organisasi

2
PEJABAT PENILAI

a. N a m a


b. N I P


c. Pangkat, Golongan Ruang


d. Jabatan / Pekerjaan


e. Unit Organisasi

3
ATASAN PEJABAT PENILAI

a. N a m a


b. N I P


c. Pangkat, Golongan Ruang


d. Jabatan / Pekerjaan


e. Unit Organisasi

4
PENILAIAN

UNSUR YANG DINILAI
NILAI


ANGKA
SEBUTAN
KETERANGAN

a. Kesetiaan




b. Prestasi Kerja




c. Tanggung Jawab




d. Ketaatan




e. Kejujuran




f. Kerjasama




g. Prakarsa




h. Kepemimpinan




i. JUMLAH









NILAI RATA-RATA




R A H A S I A
5
KEBERATAN DARI PEGAWAI NEGERI SIPIL                        
YANG DINILAI (APABILA ADA)                                                       
                                                                                 
                                                                                 
                                                                     
                                                                                 
                                                                                                                                                                                                                                                                Tanggal :

6
TANGGAPAN PEJABAT PENILAI                              
ATAS KEBERATAN                                                    
                                                                                  
                                                                                  
                                                                                                                                                         
                                                                                  
                                                                                  
                                                                                                       Tanggal :

7
KEPUTUSAN ATASAN PEJABAT PENILAI                  
ATAS KEBERATAN                                                     
                                                                                   
                                                                                   
                                                                                                                                                         
                                                                                   
                                                                                   
                                                                                                       Tanggal :

8
LAIN-LAIN













10
                                                                                               9.     DIBUAT TANGGAL        :
                                                                                                       PEJABAT PENILAI
                                                                                                                                               
                                                                                                                                               
                                                                                                                                               
DITERIMA TANGGAL    :                                                                                                         
PEGAWAI NEGERI SIPIL                                                                 Drs. I. B.  Md. Mertha, M.Si.
YANG DINILAI                                                                                NIP. 195908221979031001
                                                                                                                                               
                                                                                                                                               
                                                                                                                                               
                                                                                                                                               
…………………………………..….                                                     11.   DITERIMA TANGGAL    :
NIP.                                                                                                ATASAN PEJABAT PENILAI
                                                                                                                                               
                                       
                                                                                                                                                                                                              
                                                                                                       Prof. Dr. H. Sugijanto, MS.,Apt.
                                                                                                       NIP. 195406211980021001


R A H A S I A

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