FORMULIR LAMARAN KERJA

EMPLOYMENT APPLICATION FORM

Posisi yang dilamar / Position applied : Tanggal / Date :
Quality Control Staff
__________________________________ ___________________________
07 July 2022
DATA PRIBADI Personal Data
Nama Lengkap ___________________________
Satria Bayu Firdaus X Laki-laki Wanita
Full Name Male Female
Bekasi
Tempat Tanggal Lahir ___________________________ Warga Negara __________________________
Indonesia
Place & Date of Birth Nationality
Status Perkawinan Belum Kawin
___________________________ Tinggi/Berat 166/53
__________________________
Marital Status Height/Weight
Agama/Religion Islam
___________________________ Gol.Darah/Blood type O
_______________________
Religion Blood Type
ALAMAT Address
Alamat Tetap Permanent Address Alamat Surat Mailing Address
_______________________________________________
Perum Villa Kencana Karawang Blok C8 No12A ___________________________________________
Perum Villa Kencana Karawang Blok C8 No12A
Wancimekar, Kotabaru, Kab Karawang Wancimekar, Kotabaru, Kab Karawang
_______________________________________________ ___________________________________________
No. Tlp / Ph number 089617701529
___________________________ 082283184849
No. Tlp/Ph number __________________________
E-Mail ___________________________
Sbayu919@gmail.com E-Mail icaiktayap@gmail.com
__________________________
PENDIDIKAN FORMAL Formal Education
Jenis Sekolah Nama Sekolah Kota Jurusan Lulus Tahun
Type of School Name of Institute City Major Year of Grad.
SMP Muhammadiyah 3 Padang - 2012
SLTP ___________________________ _____________ __________ ____________
Padang IPA 2015
SLTA ___________________________
SMA Kartika Jaya 1-5 _____________ __________ ____________
Politeknik ATI Padang Analis Kimia 2018
D1 / D2 / D3 / D4 ___________________________ _____________ __________ ____________
S1 / S2 ___________________________ _____________ __________ ____________
KETRAMPILAN INFORMAL
Jenis Ketrampilan Baik / Cukup / Kurang Spesifikasi/Specification
Komputer Baik Ms Word, Ms Exel , Ms Power Point
Bahasa Asing Cukup English
Lain-lain
DATA IDENTITAS Identity Data
No. KTP/Id Card No 1371040607970005
___________________________ No. SIM/DL No -
___________________________

Berlaku sampai Seumur Hidup

___________________________ No. Rekening Tab 0322223704
___________________________
DATA KELUARGA Family Data
Nama Ayah/Ibu Estu Purnama
: ______________________________ Nama Anak :
Pendidikan S1
: ______________________________ Anak ke-1 Zendy Fitra Ezsa Pratama
: __________________________
Pekerjaan : Wiraswasta
______________________________ Usia 29 Tahun
: __________________________
Alamat Perum Villa Kencana Karawang Blok c8
______________________________ Anak ke-2 : Satria Bayu Firdaus
__________________________
Elviza Zeyn 25 Tahun
Nama Istri / Suami : ______________________________ Usia : __________________________
Pendidikan SMA
: ______________________________
Wiraswasta Kania Reva Nandita
Pekerjaan : ______________________________ Anak ke-3 : __________________________
Alamat : Perum Villa Kencana Karawabg Blok c8 Usia
______________________________ : 16 Tahun
__________________________
PELATIHAN Training
Nama / Jenis Pelatihan Penyelenggara Bulan/Tahun
Name/Type of Course Organizer/Location Month/Year
Achievment Motivation Training Politeknik ATI Padang 2017
____________________________________________ ____________________________ _____________
Bahasa Jepang
____________________________________________ Balai Latihan Kerja Padang
____________________________ 2019
_____________
____________________________________________ ____________________________ _____________
LAIN-LAIN Others
Apakah Saudara pernah menderita penyakit serius ? ________________________________________
Have you ever suffered from a serious illness ? Jenis Penyakit Bulan/Tahun menderita peny.tsb
Type of Illness Month/Year suffering illness
-
_______________ ___________________________
-

_______________ ___________________________

PENGALAMAN KERJA Working Experiences

Nama Perusahaan Jabatan/Gol Dari-Sampai (Th) Gaji Alasan Berhenti

Company Name Position/Level From - To (Year) Salary Reason of Leaving

Prima Medika Lab Inspector RM/PM 2020-2021 4.300.000.00 Pindah

___________________ ______________________________ ____________ ___________ _______________
Kalbe Inspector RM/PM
Consumer Health______________________________ 2021-2022 5.031.000.00 Habis Kontrak
___________________ ____________ ___________ _______________

___________________ ______________________________ ____________ ___________ _______________

___________________ ______________________________ ____________ ___________ _______________

___________________ ______________________________ ____________ ___________ _______________

___________________ ______________________________ ____________ ___________ _______________

___________________ ______________________________ ____________ ___________ _______________

Gaji Terakhir 5.031.000.00

: _______________________ 07 July
Tgl.:Bisa 2022
_______________________
Mulai Bekerja
Latest Salary Available Date

4.000.000.00
Gaji Yang Diharapkan : _______________________
Expected Salary
REFERENSI Reference
Nama Telpon Perusahaan Posisi / Dept. Hubungan

Pipih Rinjani Prima Medika Lab SPV QC Mantan SPV

___________________ 085224506943
______________________ ___________________________
___________________________
_______________
Restiya Suci Nugraha 0895324266010 Kalbe Consumer Analis RM/PM Mantan Rekan Kerja
___________________ ______________________ ___________________________
___________________________
_______________

Dengan ini Saya menyatakan bahwa data di atas ditulis dengan benar. Apabila dalam masa kerja nanti diketahui
bahwa data tersebut tidak benar / dipalsukan, maka Perusahaan dapat memutuskan hubungan kerja tanpa harus
membayar uang pesangon / jasa maupun ganti rugi dalam bentuk apapun.
I hereby certify that information provided herein is true to the best of my knowledge. In the event of employment, I understand
that false or misleading information provided in my application may result in termination of my employment without receiving
severance / service pay and / or compensation of any kind.

_______________________________
Nama & Tanda tangan Pelamar
Name & Signature of Applicant