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Lampiran : Isi dan bawa lampiran ini pada saat Tes

DAFTAR RIWAYAT HIDUP


I. DATA PRIBADI
Nama : .....................................................................................................................................
No. Peserta :.............................................................................................................................
Tempat/Tgl Lahir : ........................................................................................ (Umur : ..............................)
Alamat : .....................................................................................................................................
Status Perkawinan :..............................................................................................................................
Hobi/Kegemaran : .....................................................................................................................................
Orang Tua : 1. Nama Ayah : ..............................................................................................
Pekerjaan : ..............................................................................................
2. Nama Ibu : ..............................................................................................
Pekerjaan : ..............................................................................................
Jumlah Saudara : .....................................................................................................................................

Nomor STR : .................................................. Masa berlaku STR : .............................................

II. PENDIDIKAN
No. Jenjang Th. Lulusan Jurusan Nama Sekolah
1. SD
2. SMP
3. SMA
4. D3 / S1
5. *Profesi (Ners)

III. PENDIDIKAN NON FORMAL / KURSUS / PELATIHAN


No. Pendidikan/Kursus/Pelatihan Bidang Th.Kegiatan

IV. PENGALAMAN KERJA


No. Bidang Bagian Th. Kerja Nama Tempat Bekerja

V. PENGALAMAN ORGANISASI
No. Jenjang Th. Lulusan Jurusan Nama Organisasi

Palembang, .............................................

(...............................................................)

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