BSE-3.1/4.

1/1/1-1
BSE-3.1/4.1/1/1-1

HAVE YOU GOT YOUR BANK ACCOUNT ?

1. Identitas
a. Nama Mata Pelajaran : Bahasa Inggris Lintas Minat
b. Kelas / Semester : 1 /1
c. Kompetensi Dasar :

3.1 Membedakan fungsi sosial, struktur teks, dan unsur kebahasaan beberapa teks khusus dalam
bentuk formulir isian yang digunakan di perusahaan/bank/instansi lain, dengan memberi dan
meminta informasi terkait jati diri dan informasi yang relevan, sesuai dengan konteks
penggunaannya.

4.1 Menangkap makna secara kontekstual terkait fungsi sosial, struktur teks, dan unsur
kebahasaan teks khusus dalam bentuk formulir isian yang digunakan di perusahaan/bank/instansi
lain dan sesuai konteks.

d. Materi Pokok : Forms

e. Alokasi Waktu : 2 X 3 JP
f. Tujuan Pembelajaran :

Dalam pembelajaran ini, kalian akan

mempelajari beberapa bentuk formulir.
Kalian diharapkan bisa membedakan
fungsi sosial, struktur teks, unsur
kebahasaan dan informasi yang ada dalam
formulir yang kalian baca, kemudian
menangkap makna dari teks berbentuk
formulir sehingga dapat mengisi formulir.

h. Materi Pembelajaran
Fungsi sosial, struktur teks, dan unsur kebahasaan teks yang terkait dengan teks berbentuk
formulir isian.

Materi tersebut dapat kalian baca antara lain pada Buku Teks Pelajaran tentang formulir
dan sumber lain yang terkait dengan materi formulir.

i. Peta Konsep :

FORMS

DEFINITION PURPOSE TEXT LANGUAGE

STRUCTURE FEATURES

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j. Kegiatan Pembelajaran

PENDAHULUAN

Sebelum mempelajari materi, jawab pertanyaan berikut dan amati gambar dan jawab
pertanyaannya.

Answer the following questions

1. Have you ever filled in a form?
2. What kind of form ?
3. When did you fill it?
4. In what occassions do people commonly fill in a form?
5. What do you fill in the form with?
6. What is the function of a form?

Observe this form and answer the questions

a) What do you call this kind of form ?

b) What institution issued this form?
c) When someone has to fill out this form?

Main Activity

1) Read and learn the materials about FORMS

from different sources
2) Complete all the tasks in this “UKB” or on your
own book.
3) You can work individually or with your
friend(s), and if you have finished with all
the tasks, you may take the formative test and
continue to the next “UKB.”

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 ACTIVITY 1

Read the short explanation and examples below carefully!

DEFINITION: A form is a document (printed or electronic) with spaces in which we can

write or enter data.
THE PURPOSE: to convey data or short detailed information for a certain purpose.
There are many kinds of form serving different functions such as :
- Purchase form
- Order form
- Withdrawal slip
- Deposit slip
- Reservation form
- Medical form ,etc

Examples

Observe the following examples :

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Having observed the examples above, conclude what kinds of form they are.

If you’ve already been able to conclude kinds of form of the examples above, now you can
continue to the following learning activity.

ACTIVITY 2

Having learnt about kinds of forms in the examples of the 1st learning activity, now pay
attention to the social function, text structure and language features of the forms:

Social Function : Giving correct data and information

Text Structure :
The information used in a company, bank, and other institutions.
Language Features :
- The expressions and vocabulary usually used in a company, bank and other institution,
such as savings, withdrawal, invoice, saving account, medical foram, order form, etc.
- Verbs either in past tense, present tense and future tense.
- The use of pronoun either in singular and or plural
- Spelling, punctuation, and hand writing

Now, continue to the following activity!

Let’s Practice !!

actice
TASK 1

Find at least three different forms which you can find in your daily life. What do you find in the
forms?

Date
Name
Withdrawal Slip Amount of money
Signature

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 TASK 2

Complete the definitions with words provided in the brackets.

a. Order forms are used by businesses or ________ as a convenient way of ________ from customers.
They contain _________ about exactly how much a particular order will cost. (information, companies,
taking orders)
b. Feedback forms are documents used to maximize response in an unobtrusive and intuitive way from
clients or ___________ . The forms are used to provide feedbacks on performance, ___________ and
general opinions about an ________ . (organization, quality, customers)
c. Purchase forms are used to make legally binding purchase agreements between the _____ and the
buyers. They contain essential infomation such as _______ of the purchase, the terms of ________ and
warranties. (cost, sellers, payment)
d. Medical forms are used to keep __________ information about a patient that is _________ of a hospital
or a doctor. They also contain a ____________ of a patient’s medical history and care. (medical,
documentation, under the care)
e. Reservation forms are important type of documents which are used when a person wants to _________
his place or position at a __________ or an event. For example a reservation for a plane seat,
__________, a table in a restaurant, etc. ( hotel rooms, reserve, place)

TASK 3
Form 1

Answer the Questions

1. What is Alejandra Giron’s plan with the CV?
2. What skills does she have?
3. How long does she have experience working in hotels?
4. How many languages does she master?
5. What sport is she able to play?

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Form 2

Fox Valley Lutheran Highs School International Student Application Form

FAMILY INFORMATION

Student Name Last: Mahendra First : Aji Middle : Lukman

Preffered Name/Nick Name : Hendra

Address Jl. Adi Sucipto 357 Surakarta

Central Java 57175

Phone Home : 0271-782084 Cell : 08562834226

Birth Date 8/3/1998 M/F Race : Asian

(mm/dd/yyy)

Country of Birth Indonesia

Country of Indonesian
Citizenship

Entering Grade X

Student Email Aji_Lukman_mahendra @gmail.com

Father’s Name Last : Mahendra First : Gunawan

Email Gunawan.mahendra@gmail.com

Employer Indonesian Government Occupation/Position : Teacher

Phone Work : 0271- 711615 Cell : 081225070789

Mother’s Name Anita Mahadevi

Email Mahadevi.anita@ymail.com

Employer Medika Utama Hospital Occupation / Position : nurse

Phone Work : 0271- 603226 Cell : 081329006656

ADDITIONAL INFORMATION

Agency Contact Information or emergency contact if no agent exist

Name Ruli Sahetapi

Email Ruli_sahetapi88@yahoo.com

Billing Information Billing sent to this Email ? Yes NO

If “no” which email ?

Phone 024-706020

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 STUDENT ADDITIONAL BACKGROUND

Name

Tests taken : TOIEC TOEFL other

English Proficiency Score : 550 Date of test : 7/23/2013

Please list previous

schools attended

School School Name : SD Taman Siswa Surakarta

Dates of Attendance : 7/15/2005 Grade : Elementary School

Address : Jl. Hasanudin 74 City : Surakarta

State / Country : Indonesia Postal Code : 75164

Phone Number : 0271 – 634257 Fax : 0271 -634 257

School School Name : SMP Gajah Mada

Dates of Attendance : 7/12/2011 Grade : Junior High School

Address : Jl. Dr. Rajiman 56 City : Surakarta

State / Country : Indonesia Postal Code : 75164

Phone Number : 0271 – 610743 Fax : 0271 -610743

School School Name : -

Dates of Attendance : - Grade : -

Address : - City : -

State / Country : Postal Code : -

Phone Number : - Fax : -

Date Student Signature Parent Signature

........... ........................................ ..............................

Answer the Questions

1. What kind of form is it?
2. Who is supposed to fill out this form?
3. What is Aji going to do with this form?
4. Why is English qualification requested here?
5. What do you think about Aji’s English skill?
6. What school does Aji plan to study next?
7. Why is additional information requested here?
8. What previous schools did Aji attend?

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WHAT’S
NEXT?

If you’ve finished with Task 1 and Task 2, you

may continue to the next activity

Read the following information before continuing doing the next tasks

Understanding forms

Forms need to be filled in for lots of different reasons. For example, you might want to record a
complaint or fill in a course or job application form. Or you might complete a form online to find out
about jobs in your area or to book a ticket for a journey or a show. Forms can be filled in different
ways, including:

• by hand
• by word processor and signed by hand
• online (and sent online)

Before filling in any form it’s important to be sure of the purpose of the form and to
think about who might read it.

Tips

When you’re filling in a form:

• read it carefully before you start writing

• check that you understand all the language used
• make sure you understand the instructions on the form

Sometimes there are different types of questions in different sections of a form. There may be
questions with a list of possible answers and you have to choose the answer that applies to you. You
may have to circle or tick the right answer to a question, or cross out the wrong answers. If you’re
completing a form on a computer, you may have to use the mouse to click on a drop-down menu and
you then click on the answer that’s right for you.

Read the instructions (left) and explanations (right) below

Write in BLOCK CAPITALS Write the whole word in capital letters

Please tick appropriate box Put a tick in the box  that’s right for you

Delete where applicable Cross out the answers that don’t apply to you

Please print Write without joining up the letters

Please specify Please give details

There are several different ways of writing dates. The form should let you know what’s required. On
some forms, you may need to write the date in boxes.

For example, you write the day first, then the month and then the year.

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Filling in forms

We fill in forms for a wide range of purposes. As with all types of writing, we need to consider the
purpose of the form as well as who will read it. We may word process a form or complete it by
hand. We may also complete and send forms online. Some forms, such as accident-report forms,
require you to organise and report on factual information. Others, such as job-application forms,
require you to market or ‘sell yourself’ in addition to giving factual information about your experience
and skills.

Online forms
Some online forms can give you access to information on a database. This can save you time when
you’re making travel plans, or when searching for job vacancies. You can also use online forms to
make a purchase, such as booking a flight. Many companies or organisations will want you to
register with their website and they’ll ask you to complete a registration form. In this case you will
need to fill in your email address, as well as a user name and password in order to protect your
personal details.

If you’re sending payment with a form, you have to be especially careful filling in the form,
ensuring that all the details are correct. You may decide to send a cheque, credit card details, or
complete a direct debit form or bank transfer. If you’re filling in your financial details online, you need
to be sure that you are using a secure site. A secure site will have https in the address bar and there
will usually be a padlock symbol on the screen. Many forms include a question asking you if you
want to be sent further information or if you’d like to be informed of other similar products or
services. If you don’t want your personal details to be passed on to other companies, check this
section of the form carefully. If you’re completing a form online, you may have to ‘untick’ a box.
Companies have a duty to protect your personal details under the Data Protection Act.

Checking through the form

It’s important to read a form carefully before filling it in. Are there different sections in the
form? Do you have to answer different types of questions in different sections of the form? Do all
sections apply to you? On some forms, such as online registration forms, you don’t have to answer all
the questions. Questions that require an answer often have an asterisk next to them so these are the
only ones you need to complete.

Before signing a form, make sure you understand what you’re committing yourself to.
If you complete a form online, you can fill in the form and send it immediately. You won’t need to sign
an online form, but it’s important to check the form very carefully before pressing the ‘send’
button to make sure that all the information is correct. It’s also a very good idea to print and save
a copy of the form so you have a record of what you’ve completed and sent. This may also be
helpful for the next time you need to complete a similar form.

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 Next tasks will give you chances to practice completing forms. Let see whether you
could do this correctly or still make some mistakes in completing it.

TASK 4

Completing an accident report form

A short account of an accident that took place in the Wordywise store is given below.
Read the account and then extract the necessary information to complete the accident
report form. Complete the form as though you were the sales assistant who witnessed
the accident.

Accident report

It was Monday 1 June, the first day of the

Wordywise summer sale. The store had opened at
8.30 am. It was going to be a busy trading day!

Half an hour after opening time, Joanna Davies

arrived at the store to buy clothes for her summer
holidays. She headed straight for the fashion
department on the ground floor. She was so intent
on searching for bargains that she failed to see the rail of clothes that had
been left in the aisle. Joanna tripped and fell to the floor, cutting her left
knee.

A sales assistant working nearby saw what happened and rushed to her aid.
First of all she found a chair for Joanna to sit on, then called for a first-aider.
The first-aider cleaned the wound and applied a dressing. Fortunately the cut
was not too deep and Joanna soon got over the shock. After giving the sales
assistant details for the accident report form, she carried on with her bargain
hunting.

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 TASK 5

Completing a form
Your local council is holding a consultation on library services in your local area. They
want to find out what you know about your local library and what services you value. If
you’re not already a member of a library, find out what is on offer in your area. It’s free to
join! So join up and then fill in this form to make your voice heard.

Section 1

Family name: ______________________________________________________

Title (Mr/Mrs/Ms/Miss/Other) ____ Forenames: _______________________________________

Address: _____________________________________________________________________

________________________________________Postcode: ____________________________

Date of birth: _____________________________ Telephone: ___________________________

Email address: ________________________________________________________________

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 Section 2 (for people under 18) Please ask a guarantor (usually your parent or carer) to fill in this
part. They must be over 18.

Your guarantor’s name and address: _______________________________________________

_____________________________________________________________________________

Section 3 Please tick the relevant boxes to identify any library services that you have used.

Borrowing books  Reading newspapers  Borrowing DVDs/CDs 

Children’s library  Adult reading groups  Children’s storytelling 

Use of computers/internet  Film screenings  On-line reference services  Mobile library

 Home library service  Author talks  Courses 

Other services:
__________________________________________________________________

Section 4
Please use this section to state your views on your local library services. Your feedback will go straight
to the Council’s customer service centre who will direct it to the relevant department.
_____________________________________________________________________________

____________________________________________________________________________

TASK 6

Karol Kopiec is a 17-year-old Polish student at college in Gdansk. He lives with his parents and twin brother
in an apartment at 49A Kirchen Avenue, Michal Park, Gdansk 17.

He has always wanted to work in a museum because he is hoping to study archaeology when he goes to
university in twelve months’ time, when he will be 18. Karol is hoping that the recent exams he took in
history, geology and archaeology will give him the grades that he needs to study at Warsaw University.
He is waiting for the results which will arrive soon. The college he has been attending, Gdansk Training
College, will email him directly at kkopiec@museumworld.com with the results.

During the last long college holidays he worked part time for 24 hours a week as an attendant in the Local
History Museum in Gdansk. This was a six week job and he enjoyed it very much. By his fourth week, he
was given the responsibility for some low-level security, such as locking and unlocking the newspaper
archives. This museum sometimes gives visitors a special experience of what it might have been like to
live nearly 200 years ago. The attendants dress up in 19th century period costume and tell visitors what
life was like then. Karol enjoyed this opportunity to dress up as a 19th century person, because he could
talk to the visitors and also explain the history of the museum and its garden. He also got on well with the
director of the museum, Marta Gmitrzak, who has offered to give him a reference any time he needs one.

Karol’s father, Marcin, has been teaching him to drive but he only has a provisional driving licence. In four
weeks’ time Karol hopes to pass his driving test and get a full driving licence so he can travel for work and
study. This would be useful because he has seen an advertisement in the Museum Bulletin for a one-year
full time job in a big museum in Kaliningrad. If he got this job it would give him valuable practical
experience before going to university. Karol plans to apply for the job.

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Imagine you are Karol. Fill in the form on the opposite page, using the information above.

Application for Museum Worker

SECTION A: PERSONAL DETAILS

Full name: ....................................................................................................................

..........................................

Address: ......................................................................................................................
............................................

Age: ...............................................

Male/Female (please delete)

Phone/email: .................................................................................................................
......................................

SECTION B: EDUCATION AND EXPERIENCE

College attended: .............................................................................................................

..................................

Subjects studied: .............................................................................................................

...................................

Previous Experience:
Job Title Name of Workplace Length of Employment

................................................. ........................................................................................................................

Referee:
Name ..................................................................... Occupation .....................................
...............................

May we contact this person if you are invited for interview? Yes/No (please delete)

SECTION C: OTHER DETAILS

This job requires you to have a driving licence. Please indicate which type of licence you hold:
(please tick)

Full Provisional Heavy goods

Where did you find out about this job vacancy? (please circle)

Gdansk Weekly Kaliningrad Times Jobs for All Other

SECTION D:

Please write one sentence of between 12 and 20 words giving details of your most recent
museum experience.

...............................................................................................................................
.....................................................

...............................................................................................................................
.....................................................

...............................................................................................................................
.....................................................

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Now, please open the following link, do the exercise and you can check the answer after that.
https://www.youtube.com/watch?v=z9mCgCY1Cow

How is the result? Can you complete the fom correctly?

Ok, don’t worry if you haven’t got all correct answer for all the blank spaces.

You can continue open the link below to get some advice how deal with completing form task. Next you
can do the exercise given and check the answer.

https://www.youtube.com/watch?v=YP5FEfYGapY

TASK 7

Open the links below and complete the forms:

1. https://www.youtube.com/watch?v=hyM5O2A3los

2. https://www.youtube.com/watch?v=ALuMy0NxDXw

If you have finished with the task 3, come to

your teacher to check your answer.

REFLECTION
If you’ve finished with all the activities and all of them have been checked. Now, do some reflection by
answering the questions below.

NO Next
QUESTIONS YES NO

1 Have you known the definition of forms?

2 Can you explain the social function, text structure, languange features
of forms?
3 Are you able to fill in forms?

This is the end of 1st UKBM with the topic Form Completion. Next, ask your teacher to give you
Formative Text before you go to next UKBM.

GOOD LUCK.....
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