Nama : ___________________________________________________________
Nama Panggilan : ___________________________________________________________
TTL : ___________________________________________________________
Pendidikan : ___________________________________________________________
Jurusan : ___________________________________________________________
Agama : ___________________________________________________________
NIK : ___________________________________________________________
No.Telp : ___________________________________________________________
Email : ___________________________________________________________
Alamat : ___________________________________________________________
: ___________________________________________________________
Berat Badan : ___________________________________________________________
Tinggi Badan : ___________________________________________________________
Mata : Buta warna (Ya/Tidak)
: Minus (Ya/Tidak)
Hobby : ___________________________________________________________
Jumlah Keluarga : ___________________________________________________________
Nama Ayah : ___________________________________________________________
Keadaan Ayah : Masih Hidup Sakit Sudah Meninggal
Pekerjaan Ayah : ___________________________________________________________
Nama Ibu : ___________________________________________________________
Keadaan Ibu : Masih Hidup Sakit Sudah Meninggal
Pekerjaan Ibu : ___________________________________________________________
No.Telp Orang Tua/Wali: ___________________________________________________________
Kursus Populer :
Kelas Level Dasar Kelas Lanjutan Level N4
Kelas Lanjutan Level N5 Kelas Lanjutan Level N3
Penempatan Lulusan :
Magang Jepang Kemnaker RI CPMI Nurse & Careworker G to G
Magang Jepang Swasta CPMI Pekerja Berketerampilan Spesifik B to C
Tempat Kursus :
Anjatan Indramayu Klayan Majalengka