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BIODATA PESERTA

Nama Lengkap : ...................................................................................................................................


Nomor Induk Kependudukan : ...................................................................................................................................
Tempat / Tanggal Lahir : ...................................................................................................................................
Golongan Darah : ...................................................................................................................................
Jenis kelamin : ...................................................................................................................................
Nama Perusahaan : ...................................................................................................................................
Alamat Perusahaan : ...................................................................................................................................
...................................................................................................................................
Pendidikan Terakhir : ...................................................................................................................................
Pekerjaan/Jenis Alat : ...................................................................................................................................
Nomor Telepon/HP : ...................................................................................................................................
Pengalaman Training K3 : ...................................................................................................................................
...................................................................................................................................
...................................................................................................................................

, November 2022

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Lampiran Salinan KTP Peserta


Salinan Ijazah Peserta
Foto Peserta
Surat Keterangan Sehat Dari Dokter
Surat Keterangan Bekerja Dari Perusahaan

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