1. DATA PRIBADI
Nama Lengkap :……………………………………………..…………
Jenis Identitas : KTP / SIM / PASSPORT
No Identitas :……………………………………………..…………
Tempat tanggal lahir :……………………………………………..…………
Golongan Darah : ……………………………………………..…………
Alamat Sesuai :……………………………………………..…………
Identitas ……………………………………………..…………
Kode Pos : ……………………………………………..…………
Alamat Tinggal :……………………………………………..…………
Status rumah : Milik sendiri / Milik orang tua / sewa / Kost
Email :……………………………………………..…………
No Hp :……………………………………………..…………
Status : Single / Menikah/ Cerai
Jumlah Anak :……………………………………………..…………
Agama :……………………………………………..…………
Kendaraan : Mobil / Motor
Ijin Mengendarai : SIM A / SIM B / SIM C
2. URUTAN KELUARGA
3. PENDIDIKAN FORMAL
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7. KEAHLIAN LEBIH:
Nama :………………………………………………………
Alamat :………………………………………………………
Telp/Hp :……………………………………………………….
PT. PANINDO KARYA PRESISI