PT. EXCELLENT Jl. Kembang Permai II Blok I 5 No.6 Puri Indah, Jakarta Barat 11610 021- 93397876,5805352 Fax 021- 5805352, E-mail:
[email protected]
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FORMULIR PENDAFTARAN 2x3
I.
KETERANGAN PRIBADI
01.
Nama Lengkap
:
____________________________________________________ ________________________ ________________________________ ____
02.
Nama Panggilan :
____________________________________________________ ________________________ ________________________________ ____
03.
Jenis Kelamin
: (Laki – Laki / Perempuan)*
04.
Tempat Lahir
:
____________________________ ____________________________ ________________________________________________________
05.
Tanggal Lahir
:
________________________ ________________________________ ____________________________________________________ ____
06.
Agama
: (Islam / Katholik / Kristen / Buddha / Hindu)*
07.
Kewarnegaraan :
____________________________ _ _______________________________________________________ ____________________________
08.
Anak ke
:
____________________________________________________ ________________________ ________________________________ ____
09.
Jumlah saudara :
____________________________________________________ ________________________ ________________________________ ____
10.
Status
: (Kawin / Belum Kawin)*
11.
Jenis SIM
:
Keterangan :
II.
____________________________________________________ ________________________ ________________________________ ____
(*) Coret yang tidak perlu.
KETERANGAN TEMPAT TINGGAL
01.
Alamat Lengkap :
____________________________________________________ ________________________ ________________________________ ____ ____________________________________________________ ________________________ ________________________________ ____ ____________________________________________________ ________________________ ________________________________ ____
02.
No. KTP
:
____________________________________________________ ________________________ ________________________________ ____
03.
No. Tlp / HP
:
____________________________________________________ ________________________ ________________________________ ____
04.
Alamat Lain yang dapat dihubungi : __________________________ ____________________________________________ __________________ ____________________________________________________ ________________________ ________________________________ ____ ____________________________________________________ ________________________ ________________________________ ____
05.
No. Tlp / HP lain :
____________________________________________________ ________________________ ________________________________ ____ 1
III.
KETERANGAN KESEHATAN
01.
Penyakit yang pernah diderita : _______________________________________________ ________________________________________________________
IV.
02.
Pertolongan Pertama / Obat : ________________________________________________
03.
Tinggi / Berat Badan :
______________________ cm / ______________________ kg.
PENDIDIKAN
No
Pendidikan
1
Sekolah Dasar ( SD )
2
Sekolah Menengah Pertama ( SMP )
3
Sekolah Menengah Atas ( SMA )
4
Akademi
5
Sarjana ( S1 )
V. No
Asal Pendidikan
Tahun Masuk
Tahun Lulus
PENGALAMAN KERJA Nama Perusahaan
Alamat
1 2 3 4 5
Jakarta, ____________________________
PELAMAR,
( _______________________________ )
2
Jabatan
Masa Kerja