FORMULIR PENDAFTARAN ANGGOTA BARU

KOMUNITAS PELAJAR JABAR, JABODETABEK ULM

FORMULIR PENDAFTARAN RECRUITMEN
DATA PRIBADI

4x6

NO.TELP / HP
E-MAIL

NAMA LENGKAP
: EEP SUHARTO
ASAL DAERAH
: KABUPATEN INDRAMAYU
NPM/NIM
: G1F115013
FAKULTAS/ JURUSAN/ANGKATAN : PERIKANAN & KELAUTAN / ILMU KELAUTAN / 2015
GOLONGAN DARAH
: O
JENJANG PENDIDIKAN
:
DIPLOMA 3
STRATA 1
TEMPAT TANGGAL LAHIR
:INDRAMAYU, 16 JULI 1996
GENDER
: PRIA
AGAMA
: ISLAM
ALAMAT RUMAH/KOST(Sekarang)
Lengkap dengan No rumah
: Jalan Ampera Desa Bulak Lor Blok Kelir 19/05 No.29
..Kecamatan Jatibarang Kabupaten Indramayu Kode Pos. 45273
Sekarang : Jalan Intansari 2 Rt. 21 Rw. 004 No.25A Kota Banjarbaru-kalsel
KODE POS :70714 ..
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: +6289607562501.
: eepmunyamunyu@gmail.com

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SIZE BAJU (Untuk data atribut)
PENGALAMAN ORGANISASI

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PRESTASI DALAM ORGANISASI :

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MAPALA PIRANHA
OSIS SMP & SMAN 1 Jatibarang
Generations for peace Indonesia - SMP
Duta Damai Indonesia 2010
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ALASAN MASUK ULM

Mengapa saudara/i mengajukan diri, berikan alasan-alasan kuat :
1. Ingin kuliah jauh, agar bisa merasakan pengalaman berbeda dari teman-teman sebaya saya
2. Potensi alam Kalimantan sangat baik daripada Jawa utk menunjang keperluan kegiatan kuliah saya.
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RIWAYAT PENDIDIKAN :
1. SD NEGERI BULAK LOR 2
2. SMP NEGERI 1 JATIBARANG
3. SMA NEGERI 1 JATIBARANG

FORMULIR PENDAFTARAN ANGGOTA BARU

KOMUNITAS PELAJAR JABAR, JABODETABEK ULM
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TARGET SELAMA MENJADI MAHASISWA ULM:

1. Lulus paling lambat 4 tahun
2. Bermanfaat bagi orang lain dan alam Kalimantan
3. Nanang Kota Banjarbaru 2017
4. Memperkenalkan ULM ke Jawabarat
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ALASAN KENAPA BERGABUNG DENGAN KOPAJA ULM:

1. Membentuk keluarga baru di Kalimantan
2. Ajang silaturahmi dengan KOPAJA
3. Menambah pengalaman
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APAKAH ANDA BISA BERMANFAAT UNTUK MASYARAKAT:

SANGAT BISA!!!

HOBY :
1. Kuliner
3. Snorkling dan Diving
2. Menyanyi
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KELEBIHAN YANG ANDA PUNYA :

1. Loyal
2. Public speaking
3. Menyanyi
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FORMULIR PENDAFTARAN ANGGOTA BARU

KOMUNITAS PELAJAR JABAR, JABODETABEK ULM
DESKRIPSIKAN TENTANG ULM MENURUT PENDAPAT ANDA:
ULM merukapan ptn tertua di Kalimantan. Kesempatan untuk menonjol di sini sangat mudah.
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APAKAH ANDA BERMINAT DI BIDANG RISET TECHNOLOGY/RESEARCH:

YA
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Semua data/keterangan tersebut saya buat dengan jujur dan benar, dan apabila dikemudian hari diketahui
data/keterangan tersebut tidak benar, maka saya bersedia menerima sangsi penghentian anggota.

Banjarbaru, 23 September 2016

(.)
EEP SUHARTO

*) Pengumpulan paling lambat tgl 23 September 2016