No.
Registrasi : ..................
FORMULIR DATA PELAMAR
DATA DIRI
Nama
Lengkap
:
.........................................................................................................
No.
KTP
:
.........................................................................................................
Tempat
Lahir
:
.........................................................................................................
Tanggal
Lahir
:
Tgl
Bln
Thn
Jenis Kelamin
: 1. Laki-laki 2.
Perempuan
Agama
:
.........................................................................................................
Alamat Sesuai
KTP
:
.........................................................................................................
Kota / Prov.
................................................ Kode Pos
...............
Alamat Surat Menyurat
:
.........................................................................................................
Kota / Prov.
................................................ Kode Pos
...............
Nomor
Telp.
:
........................................................................................................
Nomor
Hp.
: .........................................................................................................
Alamat
E-Mail
:
.........................................................................................................
DATA LAMARAN
Nama Jabatan Yang Dilamar :
.........................................................................................................
Kode
Jabatan
:
.........................................................................................................
Kualifikasi Pendidikan
:
.........................................................................................................
Kode Tingkat Pendidikan
: .........................................................................................................
Nama Sekolah /
PT
:
........................................................................................................
Status
Akreditasi
:
........................................................................................................
Tahun
Lulus
:
........................................................................................................
Nilai rata-rata ijazah / IPK :
........................................................................................................
No.
Ijazah
:
........................................................................................................
Instansi yang mengeluarkan :
........................................................................................................
Dengan ini Saya Menyatakan bahwa data yang saya isi adalah BENAR dan
saya bersedia menerima sanksi apabila melanggar pernyataan ini.
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