PT.

PERKASA TEHNIK
Jl. Wolter Monginsidi 60C, Kebayoran Baru
Jakarta 12170, Indonesia
Tel. +62 21 7208570
www.perkasatehnik.com

FRM/PT-001
ASSET MANAGEMENT ENGINEERING CONFIDENTIAL (RAHASIA)
FORMULIR DATA KARYAWAN

PERSONAL DATA/DATA PRIBADI

Name in block letters (underline surname)
Nama (garis bawahi nama keluarga) __________________________________________________
PAS FOTO 4 X 6
Jabatan : ___________________________ Tanggal Masuk : ______ / ______ / __________

Lokasi Kerja : __________________________________

Current Address: Permanent address ( ID card valid ):
Alamat Rumah saat ini : Alamat Tetap (sesuai KTP yang berlaku):
___________________________________________________ _______________________________________________
___________________________________________________ _______________________________________________

Citizen/Kewarganegaraan: Sex/Jenis Kelamin: *) Hand Phone/Telp. Rumah:

_______________________________________ Pria / Wanita Mobile :________________________
ID / KTP No: Marital Status/Status: Telephone :_____________________
_______________________________________ Menikah / Lajang / Janda / Duda
ID / NPWP No: Religion/Agama: Office phone/Kantor:
_______________________________________ __________________________ ______________________________
Nomor KK : Email Personal:
_______________________________________ ______________________________________
Date of Birth/tgl. Lahir: BPJS Kesehatan No : BPJS Ketenagakerjaan No :
____ / ________________ / _________ _________________________ _________________________
Place of Birth/Tempat Lahir: Nomor rekening Bank : Nama Bank/ cabang :
_________________________________ _________________________ _________________________
In an emergency , which can easily be reached is:
Dalam keadaan darurat, yang mudah dihubungi adalah"
Name/nama : _____________________________ Hubungan : Istri / Suami / Adik / Kakak / Paman / Tante *)

Hand Phone/Telp. Rumah: - Mobile : _____________________________, Telephone : ______________________________

Address/Alamat : _______________________________________________________________________________________

Detail of recuring medical disabilities, if any

Keterangan cacat kesehatan, jika ada
-

DETAILS OF FAMILY INCLUDINGYOURSELF & SPOSE

DATA KELUARGA TERMASUK DIRI ANDA & SUAMI/ISTRI
Relation Name M/F Age Date of Birth Education Name of Company/School
Father
Ayah
Mother
Ibu
Sibling-1
Saudara-1
Sibling-2
Saudara-2
Sibling-3
Saudara-3
Sibling-4
Saudara-4
Spose
Suami/Istri
Child-1
Anak-1
Child-2
Anak-2
Child-3
Anak-3
EDUCATION (from secondary education onwards) PENDIDIKAN (dari pendidikan tingkat menengah & selanjutnya)
Dates/Tanggal School, College & University Highest Level Obtained
From/Dari To/Sampai Sekolah, Akademi & Universitas Indicate distinction gained
Tingkat Tertinggi yang dicapai
Elementary School / Sekolah Dasar

Junior High School / Sekolah Menengah Pertama

Senior High School / Sekolah Menengah Atas

Academy / Akademi (D3)

Bachelor / Sarjana (S1)

Master's Degree / Sarjana (S2) / (S3)

Certificate (name of institution and dates)

Sertifikasi (dengan nama instansi dan tanggal)
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
* Lampirkan Fotokopi Sertifikat
Special Training Courses (name of institutions and dates)
Kursus/Training khusus (dengan nama institusi dan tahun)
- _________________________________________________________________________________________________________
- _________________________________________________________________________________________________________
- _________________________________________________________________________________________________________
* Lampirkan Fotokopi Sertifikat
WORKING EXPERIENCE / PENGALAMAN KERJA (Perusahaan terakhir)
Month Tahun Name and Address of Employer Phone Position
Bulan Year Nama dan Alamat Kantor Telepon Posisi
From/Dari
To/Sampai
Line of Business/Bidang Usaha: No. Employee
Jumlah Karyawan

Responsible to/bertanggungjawab kepada:

Brief description of duties and responsibilities during employment

Reason for leaving

Alasan berhenti kerja
________________________

FRM/PT-001
Membership of profesional, social and sporting organisations (position and date)
Keanggotaan dari organisasi profesi, sosial dan olahraga (dengan nama organisasi, posisi dan tahun)
- ______________________________________________________________________________________________________________
- ______________________________________________________________________________________________________________
- ______________________________________________________________________________________________________________
- ______________________________________________________________________________________________________________
- ______________________________________________________________________________________________________________

LANGUAGE AND COMPUTER SKILLS (state profeciency as Excellent/Good/Fair/Elementry)

Language Indonesian English Mandarin Others
Proficiency in
Speaking
Listening
Reading
Writing

Sofware Version Proficiency Level of Language

OTHER INFORMATION/S/INFORMASI LAIN

Please give details of the important aspect of your experience and any additional information
Berikan keterangan aspek penting dari pengalaman Anda dan informasi lainnya yang dianggap berhubungan?
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________

I herewith confirm thatallgiven information in this form are complete and true.
Saya menyatakan bahwa semua informasi dalam formulir ini lengkap dan benar

Signature, Name Place, Date

Tandatangan, Nama Tempat, Tanggal

____________________

___________________________________________ ____ /____ / __________

Nama Lengkap sesuai KTP

FRM/PT-001