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FORMULIR No. Dok. HI-F-09-01-01

DATA DIRI KARYAWAN Revisi 0
Tgl. Terbit 16 Juni 2021

Nama Lengkap :
Full Name

Tanggal Lahir (Umur) :

Date of Birth (age)

Tempat Lahir :
Place of Birth

Kelamin :
Sex

Status Perkawinan :
Marital Status

Kewarganegaraan :
Nationality

Agama :
Religion

Alamat tetap & No. Telp. (jika ada) :

Permanent Address/Telephone (if any)

Alamat sekarang jika berbeda dengan di atas :

Present Address if different from above

Nomor KTP :
Identify Card No.

Tinggi & Berat Badan :

Height & Weight

Keadaan kesehatan saat ini :

Present health condition

PENDIDIKAN FORMAL
FORMAL EDUCATION

Nama Sekolah Dari - Sampai Jurusan Lulus

Name of School From To Subject Graduate

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FORMULIR No. Dok. HI-F-09-02-00
DATA DIRI Revisi 0
Tgl. Terbit 16 Juni 2021

PENDIDIKAN LAIN (KURSUS DLL.)

OTHER EDUCATION (COURSE ETC.)

Nama Kursus Dari - Sampai Jurusan Keterangan

Name of Course From To Subject Remark

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BAHASA YANG DIKUASAI

LANGUAGE PROFICIENCY

Bahasa Lisan Tulisan

Language Oral Written

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PENGALAMAN KERJA
WORKING EXPERIENCE

Nama Perusahaan Dari - Sampai Tugas dan Gaji Alasan Berhenti

Name of Company From To Tanggungjawab utama Salary Reason of
Main responsibility Resignation

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Beri gambaran singkat mengenai karier yang anda harapkan:

Give a brief description of the career you hope to follow

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FORMULIR No. Dok. HI-F-09-02-00
DATA DIRI Revisi 0
Tgl. Terbit 16 Juni 2021

DATA KELUARGA
FAMILY DATA

Hubungan Name Tempat , tgl lahir/Umur Pekerjaan/Sekolah

Relation Name Place,Date of Birth/Age Occupation/School

Bapak
Father ............................. ..................................... .................................
Ibu
Mother ............................. ..................................... .................................
Kakak/Adik
Brothers/Sisters ............................. ..................................... .................................

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Istri/Suami
Wife/Husband ............................. ..................................... .................................
Anak-anak
Children ............................. ..................................... .................................

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Berikan gambaran singkat tentang diri anda dalam hal kelebihan atau kelemahan
Give a brief description about your strength and weakness

Kelebihan Kelemahan
Strength Weakness

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Kegiatan-kegiatan diluar pekerjaan:

Activities outside the job

Hobby: :
Hobbies
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FORMULIR No. Dok. HI-F-09-02-00
DATA DIRI Revisi 0
Tgl. Terbit 16 Juni 2021

Organisasi-organisasi (sosial,politik, profesi,dll.)

Organizations (sosial, politic, professional,etc.)

Nama Organisasi Jabatan di organisasi

Name of organization Position held

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Sedang dalam proses pengajuan beasiswa?

In process of apply for scholarship?
Jika ya, cantumkan nama lembaga dan tempat anda mengajukan beasiswa
If yes, please give the institution name and place you are applied in

Lembaga Tempat
Institution Place

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Sedang dalam proses rekrutmen dan seleksi di perusahaan lain?

In process of recruitment & selection in other company?
Jika ya, cantumkan nama perusahaan dan posisi pekerjaannya
If yes, please give company name and the job position

Perusahaan Posisi Pekerjaan

Company Job Position

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Anda melamar melalui Iklan/Kawan/Keluarga :

Please mention you apply via Advertisement/Friend/Family

Jika diperkenalkan oleh Kawan/Keluarga sebutkan namanya:

If introduced by Friend/Relative please mention the name
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FORMULIR No. Dok. HI-F-09-02-00
DATA DIRI Revisi 0
Tgl. Terbit 16 Juni 2021

Catatan lain :
Others remark

Apakah anda mempunyai saudara atau kawan yang bekerja di PT HELINDO tech Indonesia?
Do you have relative of friends working in Indonesian Clearing & Guarantee Corporation?

Jika ya, cantumkan nama dan bagian tempat kerjanya

If yes, please give names and department they are employed in

Nama Hubungan Bekerja di bagian

Name Relationship Name of departments

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Bila dikemudian hari data-data yang diberikan ternyata tidak benar, saya
bertanggungjawab penuh dan bersedia dijatuhi sanksi menurut peraturan yang
berlaku di perusahaan.
If in the future the information given above turns out to be false, I am prepared to
assume responsibility and should accept any sanction against me according to the
company regulation.

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