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E-FORM DATA FOR INTERNAL HIRING NOTIFICATION Personal Data:
Your data: Title (Mr/Ms/Mrs) Mr Full Name (Exactly as stated in KTP) A. M. Qomar NPWP No. Date of Birth (dd.mm.yyyy) 12.03.1991 Place of Birth (City) Baubau Country of Birth Indonesia KTP No. 7371131203910000 Nationality Indonesian Religion (Buddhist/Christianity/Hindu/Muslim/Roman Catholic)Muslim Marital Status (Married/Single) Single If Married, Date of Marriage (dd.mm.yyyy)
Address: House No. & Street (Exactly as stated in KTP & No need for punctuation) Jl. Bonto Dg Ngirate, Blok 20, No. 76 RT … RW … Kelurahan … RT 003 RW 006 Bonto Makkio Postal Code 90222 City Makassar District (Kecamatan) Rappocini Region (e.g. Jawa Barat, Sulawesi Barat, etc.) Sulawesi Selatan Country Indonesia Mobile No. 085255705309 Home Phone No.
Address (emergency contact): C/O (Name of the person & relationship) Drs. H. Kamaruddin, S.H. - Father House No. & Street (Exactly as stated in KTP & No need for punctuation) Jl. Latsitarda, No. 3 RT … RW … Kelurahan … RT 002 RW 003 Lamangga Postal Code City Baubau District (Kecamatan) Betoambari Region (e.g. Jawa Barat, Sulawesi Barat, etc.) Sulawesi Tenggara Country Indonesia Mobile No. 081341615309 Home Phone No. (0402) 2824226
Bank Information: Your Full Name (Exactly as stated in Book Bank Account) Bank Account No. Bank Name (BCA / BNI / etc.) Bank Branch Bank Address Bank City
Ahmad Muhammad Qomar 1665-01-000138-50-1 BRI KK UIN Makassar Jl. Sultan Alauddin, Samata, Gowa Gowa
Family Information (Mother): Full Name of Mother Date of Birth (of Mother) (dd.mm.yyyy) Place of Birth (of Mother)
Family Information (if Married): Full Name of Spouse Marriage Certificat No Date of Birth (of Spouse) (dd.mm.yyyy) Place of Birth (of Spouse)
Family Information (Child, if any*):
Hj. Andi Nahmawati 19.09.1965 Raha
Full Name of Child Date of Birth (of Child) (dd.mm.yyyy) Place of Birth (of Child) No. of Child (1/2/3/etc) Gender (Male/Female)
University Information: Start Date (dd.mm.yyyy) Graduation Date (dd.mm.yyyy) Institute Location Certificate Duration (years) Branch of Study
Previous Employer Details: Start Date End Date Employer Location Industry Job Functional Area Country
27.08.2009 31.12.2013 Islamic State University of Alauddin Makassar S1 Health Education 4 Pharmacy
E-FORM DATA FOR INTERNAL HIRING NOTIFICATION Example: Mrs Ve Rona Lembayung Senja 555444333888888 01.01.1999 Jakarta Indonesia 4443335558888888 Indonesian Muslim Married 01.07.2012
Jl Mawar Melati Blok SX No 7 RT 008 RW 008 Pondok Hijau 12320 Bekasi Pekayon Jawa Barart Indonesia 0818008808 02199326890
Abdul Hasan - Father Jl Mawar Melati Blok SX No 7 RT 008 RW 008 Pondok Hijau 12320 Bekasi Pekayon Jawa Barart Indonesia 081808111560 02199326890
Ve Rona Lembayung Senja 0028122323 Bank Central America KCP Bekasi Jl HOS Cokroaminoto No. 8 Bekasi
Kristina Noor 20.03.1954 Jember
Denzel Ilham Putra 329/7/2012 06.06.1986 Cirebon
01.09.1997 30.05.2002 Harvard University Jakarta S1 Bachelor 4 Human Resources Management
01.05.2006 31.11.2012 PT. Angin Sepoi-Sepoi Banjarmasin Manufacturing Marketing Officer Sales Indonesia