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Form Data Karyawan

Form Data Karyawan

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Published by: usugiharta on Jan 05, 2011
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08/25/2015

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Date: ______ / ______ / _______

Nama Karyawan : ________________________________________________________________
Tempat/Tanggal Lahir : _____________, ______________ Gol. Darah :
Agama : ________________________________________________________________
Nomor Karyawan : ______________________________________________ Laki-laki / Perempuan
Tanggal ulai !eker"a : ________________________________________________________________
Departemen : ________________________________________________________________
#a$atan : ________________________________________________________________
No. #am%o%tek : ______________________________
&tatu% : !elum Kawin Kawin #an'a Du'a
Alamat Tetap : ________________________________________________________________
________________________________________________________________
Telp. / (P _______________________________________________________
Alamat &ekarang : ________________________________________________________________
________________________________________________________________
Telp. / (P _______________________________________________________
K)L*A+GA
Nama Istri / Suami : ________________________________________________________________
Tempat / Tanggal Lahir : ________________________________________________________________
Alamat : ________________________________________________________________
________________________________________________________________
Telp. / (P _______________________________________________________
Peker"aan : ________________________________________________________________
Nama Peru%ahaan : ________________________________________________________________
#a$atan : ________________________________________________________________
Alamat Peru%ahaan : ________________________________________________________________
________________________________________________________________
Telp. _________________________ ,a-. ___________________________
#aminan Ke%ehatan Peru%ahaan
A&K)& No. ___________________________ #A&.&T)K No. _________________________
A%uran%i lain ___________________________ +eim$ur%e / Diganti Peru%ahaan
/atatan:
0. Lampirkan &urat Keterangan 1Akte2 Kawin / /erai, &urat Keterangan 1Akte2 lahir anak.
3. Lampirkan &urat Keterangan Ker"a 4%tri / &uami 'ari Peru%ahaan tempatnya $eker"a 'an &urat Keterangan &ekolah 'ari anak.
5. Lampirkan &urat Keterangan eninggal 'ari 4%tri / &uami apa$ila %u'ah meninggal
Nama Anak Pertama : ________________________________________________________________
Page 0 o6 3
D A T A K A R Y A W A N
Tempat / Tanggal Lahir : ________________________________________________________________

#eni% Kelamin : Laki Perempuan *mur:
&tatu% : Kawin !elum Kawin
Alamat : ________________________________________________________________
________________________________Telp / (P________________________

Pen'i'ikan &D &P &A D4PL.A *N47)+&4TA&
Nama &ekolah / *ni8er%ita% : ____________________________________________________ Kela% _________ &eme%ter
Alamat &ekolah : ___________________________________________________________________ Telp.
Peker"aan : !eker"a Ti'ak !eker"a
Nama Peru%ahaan : ____________________________________________________________________ Telp. _______________
#a$atan : ________________________________________________________________________________________
Alamat Peru%ahaan : ________________________________________________________________________________________
Nama Anak Kedua : ________________________________________________________________
Tempat / Tanggal Lahir : ________________________________________________________________
#eni% Kelamin : Laki Perempuan *mur:
&tatu% : Kawin !elum Kawin
Alamat : ________________________________________________________________
_________________________________Telp / (P_______________________
Pen'i'ikan &D &P &A D4PL.A *N47)+&4TA&
Nama &ekolah / *ni8er%ita% : _____________________________________________________Kela% _________ &eme%ter
Alamat &ekolah / *ni8er%ita% : ___________________________________________________________________ Telp.
Peker"aan : !eker"a Ti'ak !eker"a
Nama Peru%ahaan : ___________________________________________________________________ Telp. ________________
#a$atan : ________________________________________________________________________________________
Alamat Peru%ahaan : ________________________________________________________________________________________

Nama Anak Ketiga : ________________________________________________________________
Tempat / Tanggal Lahir : ________________________________________________________________
#eni% Kelamin : Laki Perempuan *mur:
&tatu% : Kawin !elum Kawin
Alamat : ________________________________________________________________
________________________________Telp / (P________________________

Pen'i'ikan &D &P &A D4PL.A *N47)+&4TA&
Nama &ekolah / *ni8er%ita% : _____________________________________________________ Kela% _________ &eme%ter
Alamat &ekolah : ___________________________________________________________________ Telp.
Peker"aan : !eker"a Ti'ak !eker"a
Nama Peru%ahaan : ___________________________________________________________________ Telp. ________________
#a$atan : ________________________________________________________________________________________
Alamat Peru%ahaan : ________________________________________________________________________________________

Dalam keadaan darurat siapa yang dapat dihubungi:
Nama : ____________________________________________ (u$ungan: __________________________________
Alamat : ____________________________________________________________Telp / (P
Semua keterangan di atas diberikan dengan sebenarnya dan siap dikenakan sangsi apabila ada keterangan yang dipalsukan.
1____________________________2
Tan'a Tangan Karyawan
Page 3 o6 3

_______________ : ________________________________________________________________________________________ : ________________________________________________________________________________________ : ________________________________________________________________ : ________________________________________________________________ : : Laki Kawin Perempuan Belum Kawin Umur: Tempat / Tanggal Lahir Jenis Kelamin Status Alamat : ________________________________________________________________ _________________________________Telp / HP_______________________ Pendidikan SD SMP SMA DIPLOMA UNIVERSITAS Nama Sekolah / Universitas Alamat Sekolah / Universitas Pekerjaan Nama Perusahaan Jabatan Alamat Perusahaan Nama Anak Ketiga Tempat / Tanggal Lahir Jenis Kelamin Status Alamat : _____________________________________________________Kelas _________ Semester : ___________________________________________________________________ Telp. (____________________________) Tanda Tangan Karyawan Page 2 of 2 . : Bekerja Tidak Bekerja : ___________________________________________________________________ Telp. ________________ : ________________________________________________________________________________________ : ________________________________________________________________________________________ : ________________________________________________________________ : ________________________________________________________________ : : Laki Kawin Perempuan Belum Kawin Umur: : ________________________________________________________________ ________________________________Telp / HP________________________ Pendidikan Alamat Sekolah Pekerjaan Nama Perusahaan Jabatan Alamat Perusahaan SD SMP SMA DIPLOMA UNIVERSITAS Nama Sekolah / Universitas : _____________________________________________________ Kelas _________ Semester : ___________________________________________________________________ Telp. : Bekerja Tidak Bekerja : ____________________________________________________________________ Telp. ________________ : ________________________________________________________________________________________ : ________________________________________________________________________________________ Dalam keadaan darurat siapa yang dapat dihubungi: Nama Alamat : ____________________________________________ Hubungan: __________________________________ : ____________________________________________________________Telp / HP Semua keterangan di atas diberikan dengan sebenarnya dan siap dikenakan sangsi apabila ada keterangan yang dipalsukan.Tempat / Tanggal Lahir Jenis Kelamin Status Alamat : ________________________________________________________________ : : Laki Kawin Perempuan Belum Kawin Umur: : ________________________________________________________________ ________________________________Telp / HP________________________ Pendidikan Alamat Sekolah Pekerjaan Nama Perusahaan Jabatan Alamat Perusahaan Nama Anak Kedua SD SMP SMA DIPLOMA UNIVERSITAS Nama Sekolah / Universitas : ____________________________________________________ Kelas _________ Semester : ___________________________________________________________________ Telp. : Bekerja Tidak Bekerja : ___________________________________________________________________ Telp.

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