" "FORMULIR DATA KARYAWAN " "
" "(Diisi dengan benar, lengkap dan dengan huruf cetak) " "
"1. "Nama Lengkap ": "MAULANA DWI FADILAH " L / P "
"2. "Tempat / Tanggal ": "MALANG / 03 OKTOBER 1989 "
" "Lahir " " "
"3. "Alamat " " "
" "1. Rumah ": "JL. HAMID RUSDI 1 / 38 A RT. 04 RW. 10 KEL. BUNULREJO "
" " " "KEC. BLIMBING "
" " " " "
" " " "Kota MALANG "
" " " "Kode Pos 65123 "
" "2. Email ": "
[email protected] "
"4. "Nomor Telepon Rumah": " - Nomor HP : "
" " " "089 701 600 79 / 081 216 829 929 "
"5. "Kewarganegaraan ": "INDONESIA "
"6. "Agama /Kepercayaan ": " Islam Kristen Katholik Hindu Hindu Budha "
" " " "…............. "
"7. "Golongan Darah ": " A B AB O "
"8. "Status Perkawinan ": " Lajang Kawin Janda / "
" " " "Duda "
9. Pendidikan Formal
" "Nama "Jurusan "Kota "Mulai "
"Jenjang "Sekolah " " " "
" " "Bln "Th. "Bln "Th. " "
"- "- "- "- "- "- "- "
"- "- "- "- "- "- "- "
11. Bahasa Yang dikuasai :
"NO "Bahasa asing yang "Lisan "Tulisan "
" "Dikuasai " " "
" " "Baik "Sedang "Kurang "Baik "Sedang "Kurang "
"1. "INGGRIS " "V " " "V " "
"- "- "- "- "- "- "- "- "
12. Pengalaman Organisasi :
"NO "Nama Organisasi / "Tahun "Jabatan "Keterangan "
" "Perkumpulan yang Pernah " " " "
" "Diikuti " " " "
" " "Dari "Sampai " " "
"1. "KARANG TARUNA WARGA "2007 "2008 "WAKIL KETUA " "
"2. "UKM OLAH RAGA POLINEMA "2008 "2009 "ANGGOTA " "
"- "- "- "- "- "- "
"13."Bila Anda masih bekerja saat ini, tunjangan apa yang Anda terima ? "
" "1. TRASPORTASI TIAP BULAN " 2. BPJS KESEHATAN "
" "3. TUNJANGAN PRESTASI TIAP TAHUN " 4. ASURANSI KESEHATAN EQUITY LIFE "
" "5. TUNJANGAN HARI RAYA "
"14."Gaji dan tunjangan / Fasilitas yang "Gaji "2.800.000 "
" "diinginkan ? ": " "
" "Tunjangan / faslitas "TUNJANGAN PRESTASI TIAP TAHUN "
" ": " "
" " "TUNJANGAN HARI RAYA "
" " 3. TUNJANGAN "
" "KESEHATAN "
"15."Pernahkah Anda bekerja di Perusahaan atau Anak Perusahaan ini sebelumnya ? "
" " "
" " "
" "Ya Tidak "
" " "
" "Jika "Ya" kapan dan menjabat sebagai sebagai apa "
" "- "
"16."Adakah keluarga atau kenalan Anda bekerja pada Perusahaan atau Anak Perusahaan "
" "ini ? "
" " "
" "Ya Tidak "
" " "
" "Jika "Ya" sebutkan nama, jabatan serta hubungan kekeluargaan Anda dengan ybs. "
" " "
" "- "
17. Data Keluarga Karyawan
" "Lahir "Pekerjaan "
"Nama Suami / Istri " " "
" "Tempat "Tgl/ Bln/ Th " "
"- "- "- "- "
" "Nama Anak "Lahir "Status "Pendidikan/ Pekerjaan"
"NO " "Tgl/ Bln/ Th "Kawin / Tidak" "
"1. "- "- "- "- "
"2. "- "- "- "- "
"NO "Nama Orang Tua "Lahir "Pendidikan "Pekerjaan "
" " "Tgl/ Bln/ Th " " "
"1. "MOCH. SUTIKNO "5 JUNI 1962 "SMA "SWASTA "
"2. "SUNARTI "22 FEBRUARI "SMP "PENSIUNAN PNS "
" " "1955 " " "
" "Nama Mertua "Lahir "Pendidikan "Pekerjaan "
" " "Tgl/ Bln/ Th " " "
"1."- "- "- "- "
"2."- "- "- "- "
" "Nama Saudara Kandung "Lahir "Pendidikan "Pekerjaan "
" " "Tgl/ Bln/ Th " " "
"1."DEVI EKA SUKMA A "17 DESEMBER "D3 "BUMN "
" " "1987 " " "
"2."CHOIRUL DIKA R "5 OKTOKBER "- "- "
" " "1995 " " "
"3."- "- "- "- "
18. Yang dapat dihubungi dalam keadaan darurat :
"Nama "SUNARTI "
"Hubungan "IBU "
"Alamat "JL. HAMID RUSDI 1 / 38 A MALANG "
"Telepon "081 217 141 129 / 085 646 810 204 "
19. Referensi :
" "Nama Pemberi Referensi "Alamat & No Telepon "Jabatan "Keterangan "
"- "- "- "- "- "
"- "- "- "- "- "
"- "- "- "- "- "
20. Riwayat Pekerjaan
"Bulan/Tahun "Nama & Alamat "Jabatan "Tugas Utama "Gaji "Benefit "Alasan Pindah "
" "Perusahaan " " "Terakhir " "Pekerjaan "
"Dari "Sampai " " " " " " "
"SEPTEMBER"NOVEMBER "PT. INDOMARCO "ASS. KEPALA"Mengontrol stock "1.450.000"TUNJANGAN"Mencari "
"2010 "2011 "PRISMATAMA "TOKO "barang agar tidak" "PRESTASI "Kesejahteraan "
" " " " "stock out di toko" " "lebih baik "
"JANUARI "SEKARANG "PT. SOFTEX INDONESIA "MAINTENANCE"Bertanggung jawab"2.766.000"TUNJANGAN"Lebih dekat "
"2012 " " "PLANNER "terhadap IFS " "PRESTASI,"dengan kampung "
" " " "STAFF "Maintenance " "EQUITY "halaman dan "
" " " " "System. " " "keluarga "
" " " " " " " " "
" " " " " " " " "
" " " " " " " " "
" " " " " " " " "
" " " " " " " " "
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-----------------------
Demikian keterangan ini saya buat dengan sebenar – benarnya, jika
dikemudian hari ternyata keterangan tsb diatas terbukti tidak benar dan /
palsu, maka saya bertanggung jawab atas segala akibat yang ditimbulkan dan
menerima sanksi sesuai dengan Peraturan yang berlaku.
14 Mei 2014
(Maulana Dwi Fadilah Amd)
Gambarkan jabatan yang terakhir Anda pegang di Perusahaan dalam
bagan organisasi yang sederhana.
