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PT ASTA NADI KARYA UTAMA

Komplek Pertokoan Istana Kuta Galeria Central Parkir Blok Rs No. 11 Badung – Bali 80361
Telp : (0361) 769411 Email : info@asta-academy.com

FORMULIR PENDAFTARAN
PENDIDIKAN DASAR SATPAM GADA PRATAMA
TAHUN 2018

I. IDENTITAS PEMOHON
1. Nama sesuai Ijazah :........................................................................................
2. TTL Sesuai Ijazah : ........................................................................................
3. Jenis Kelamin :........................................................................................
4. Pendidikan Terakhir :........................................................................................
5. Pekerjaan /Unit Kerja : ........................................................................................
6. Jabatan : ........................................................................................
7. Alamat Lengkap : ........................................................................................
8. Alamat pemohon : ........................................................................................
9. No Hp : ........................................................................................
10. Nama BUJP/Agent : ........................................................................................

II. SINYALEMEN :
Tinggi badan : ..................................................................................
Berat badan : ..................................................................................
Golongan Darah : ..................................................................................
Rumus Sidik jari : ..................................................................................

Badung, - - 2018

Tanda tangan

Persyaratan :
1. Pas Photo latar belakang biru, ukuran (2x3), (3x4) ,(4x6) Pas Photo
mengunakan pakaian PDH masing- masing 4 lembar. 2x3
2. Photo copy ijazah Terakhir.
3. Photo Copy KTP & KK
4. Photo Copy SKCK/ Rumus Sidik Jari
5. Surat Keterangan Sehat dari Dokter. Jangan ditulis nama terang

Note :
Lengkapi Persyaratan Pada Saat Ngumpul Formulir Pendaftaran.

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