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Dokumen memuat identitas pemohon, termasuk nama lengkap, alamat KTP dan domisili, tempat serta tanggal lahir, jenis kelamin, tahun lulusan, nomor STRTKL, nomor telepon, dan alamat email. Menguraikan pengajuan SIPTKL, data fasilitas pelayanan dan alamat praktik, serta daftar berkas lampiran yang harus disertakan untuk pertimbangan.",{"@graph":51,"@context":100},[52,68,83],{"@type":53,"itemListElement":54},"BreadcrumbList",[55,59,62,65],{"item":56,"name":57,"@type":58,"position":9},"https://docshare.wps.com","Home","ListItem",{"item":60,"name":10,"@type":58,"position":61},"https://docshare.wps.com/id/template/",2,{"item":63,"name":35,"@type":58,"position":64},"https://docshare.wps.com/id/template/surat/",3,{"item":66,"name":47,"@type":58,"position":67},"https://docshare.wps.com/id/template/application-for-practice-permit-for-environmental-health-workers/236301/",4,{"url":66,"name":47,"@type":69,"author":70,"headline":47,"publisher":73,"fileFormat":76,"inLanguage":45,"description":49,"dateModified":77,"datePublished":77,"encodingFormat":76,"isAccessibleForFree":78,"interactionStatistic":79},"DigitalDocument",{"name":71,"@type":72},"supergirl","Person",{"url":56,"name":74,"@type":75},"DocShare","Organization","application/pdf","2026-09-11",true,{"@type":80,"interactionType":81,"userInteractionCount":4},"InteractionCounter",{"@type":82},"ViewAction",{"@type":84,"mainEntity":85},"FAQPage",[86,92,96],{"name":87,"@type":88,"acceptedAnswer":89},"Dokumen ini ditujukan kepada siapa?","Question",{"text":90,"@type":91},"Ditujukan kepada Kepala Dinas Penanaman Modal dan Pelayanan Terpadu Kabupaten Bantul di Bantul.","Answer",{"name":93,"@type":88,"acceptedAnswer":94},"Data apa saja yang harus diisi pada identitas pemohon?",{"text":95,"@type":91},"Nama lengkap, alamat KTP, alamat domisili, tempat dan tanggal lahir, jenis kelamin, tahun lulusan, nomor STRTKL, nomor telepon (SMS), serta alamat email.",{"name":97,"@type":88,"acceptedAnswer":98},"Lampiran apa saja yang harus disertakan untuk permohonan SIPTKL?",{"text":99,"@type":91},"Meliputi fotokopi KTP yang masih berlaku, surat pernyataan domisili bermaterai (jika tidak sesuai KTP), fotokopi ijazah yang dilegalisir, fotokopi STRTKL yang masih berlaku, surat keterangan sehat, surat pernyataan memiliki tempat kerja, softcopy foto 4x6 latar merah, rekomendasi HAKLI, rekomendasi dari Dinas Kesehatan, serta SIPTKL pertama bila pengajuan merupakan permohonan kedua.","https://schema.org",{"og:url":66,"og:type":102,"og:title":47,"og:site_name":74,"og:description":49},"article",{"robots":104,"canonical":66},"index,follow",{"doc_id":106,"site_id":44},236301,1789104401,{"code":4,"msg":5,"data":109},{"doc_id":106,"user_id":110,"nickname":71,"user_avatar":111,"doc_module":9,"category_id":34,"category_name":35,"doc_title":47,"doc_description":49,"doc_content":112,"file_id":113,"file_url":114,"file_type":115,"file_size":116,"view_count":4,"is_deleted":4,"is_public":9,"is_downloadable":9,"audit_status":9,"page_count":9,"language":117,"language_code":45,"site_id":44,"html_lang":45,"table_of_contents":118,"faqs":119,"seo_title":120,"seo_description":49,"update_tm":107,"read_time":4},962088121634,"https://ap-avatar.wpscdn.com/davatar_9964176cb1d06d4a9deccf72a44ae3dc","Perihal : Permohonan Surat Izin Praktik Tenaga Kesehatan Lingkungan  \nLampiran : 1 (satu) bendel  \nKepada Yth  \nKepala Dinas Penanaman Modal dan Pelayanan Terpadu Kabupaten Bantul  \nDi Bantul  \nDengan hormat,  \nYang bertanda tangan di bawah ini,  \nNama Lengkap : .......................................................... ....................  \nAlamat KTP : .......................................................... ....................  \nAlamat Domisili :    \nTempat, Tgl lahir : .......................................................... ....................  \nJenis Kelamin :    \nTahun Lulusan :    \nNomor STRTKL : .......................................................... ....................  \nNomor Telepon (SMS) : .......................................................... ....................  \nAlamat Email : ...............................................   .................  \nDengan ini mengajukan permohonan untuk mendapatkan Surat Izin Praktik Tenaga Kesehatan Lingkungan (SIPTKL) pada :  \nNama Fasilitas Pelayanan Kesehatan :……………………………………………… Alamat Praktik : ..............................................    \nNomor Telepon : ............................................... ........  \nSebagaai bahan pertimbangan bersama ini kami lampirkan :  \n1. fotokopi Kartu Tanda Penduduk (KTP) pemohon yang masih berlaku;  \n2. surat pernyataan domisili bermaterai yang disahkan oleh desa setempat (bagi yang alamat KTP tidak sesuai dengan alamat tempat tinggal);  \n3. fotokopi ijazah yang dilegalisir;  \n4. fotokopi STRTKL yang masih berlaku;  \n5. surat keterangan sehat dari dokter yang memiliki Surat Izin Praktik;  \n6. surat pernyataan memiliki tempat kerja di fasilitas pelayanan Kesehatan yang bersangkutan;  \n7. softcopy foto berwarna terbaru ukuran 4 x 6 berlatar belakang merah (dalam format jpeg);  \n8. rekomendasi dari organisasi profesi (HAKLI) setempat;  \n9. rekomendasi dari Dinas Kesehatan (dari DInas Kesehatan langsung terkirim ke DPMPT); dan  \n10.SIPTKL pertama (untuk permohonan SIPTKL yang kedua) .  \nDemikian permohonan ini disampaikan, atas perhatiannya diucapkan terima kasih.  \nBantul, ......................20.. Pemohon  \n...........................................","cbCairXR7ZYcStIg","https://ap.wps.com/l/cbCairXR7ZYcStIg","pdf",57854,"Indonesian","# Perihal\n## Lampiran\n# Identitas Pemohon\n## Data Fasilitas dan Alamat Praktik\n# Permohonan dan Lampiran Berkas\n## Pernyataan Penutup dan Tanda Tangan","[{\"question\":\"Dokumen ini ditujukan kepada siapa?\",\"answer\":\"Ditujukan kepada Kepala Dinas Penanaman Modal dan Pelayanan Terpadu Kabupaten Bantul di Bantul.\"},{\"question\":\"Data apa saja yang harus diisi pada identitas pemohon?\",\"answer\":\"Nama lengkap, alamat KTP, alamat domisili, tempat dan tanggal lahir, jenis kelamin, tahun lulusan, nomor STRTKL, nomor telepon (SMS), serta alamat email.\"},{\"question\":\"Lampiran apa saja yang harus disertakan untuk permohonan SIPTKL?\",\"answer\":\"Meliputi fotokopi KTP yang masih berlaku, surat pernyataan domisili bermaterai (jika tidak sesuai KTP), fotokopi ijazah yang dilegalisir, fotokopi STRTKL yang masih berlaku, surat keterangan sehat, surat pernyataan memiliki tempat kerja, softcopy foto 4x6 latar merah, rekomendasi HAKLI, rekomendasi dari Dinas Kesehatan, serta SIPTKL pertama bila pengajuan merupakan permohonan kedua.\"}]","Permohonan Surat Izin Praktik Tenaga Kesehatan Lingkungan | PDF"]