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FORMULIR PENDAFTARAN ANGGOTA BARU

KOMUNITAS PELAJAR JABAR, JABODETABEK ULM
FORMULIR PENDAFTARAN RECRUITMEN
DATA PRIBADI

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NO.TELP / HP
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NAMA LENGKAP
: EEP SUHARTO
ASAL DAERAH
: KABUPATEN INDRAMAYU
NPM/NIM
: G1F115013
FAKULTAS/ JURUSAN/ANGKATAN : PERIKANAN & KELAUTAN / ILMU KELAUTAN / 2015
GOLONGAN DARAH
: O
JENJANG PENDIDIKAN
:
DIPLOMA 3
STRATA 1
TEMPAT TANGGAL LAHIR
:INDRAMAYU, 16 JULI 1996
GENDER
: PRIA
AGAMA
: ISLAM
ALAMAT RUMAH/KOST(Sekarang)
Lengkap dengan No rumah
: Jalan Ampera Desa Bulak Lor Blok Kelir 19/05 No.29
…………………………..…Kecamatan Jatibarang Kabupaten Indramayu Kode Pos. 45273
Sekarang : Jalan Intansari 2 Rt. 21 Rw. 004 No.25A Kota Banjarbaru-kalsel
KODE POS :70714 .…………………………….……
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: +6289607562501…………………………………………………………….
: eepmunyamunyu@gmail.com

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PENGALAMAN ORGANISASI

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PRESTASI DALAM ORGANISASI :

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MAPALA PIRANHA
OSIS SMP & SMAN 1 Jatibarang
Generations for peace Indonesia - SMP
Duta Damai Indonesia 2010
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ALASAN MASUK ULM
Mengapa saudara/i mengajukan diri, berikan alasan-alasan kuat :
1. Ingin kuliah jauh, agar bisa merasakan pengalaman berbeda dari teman-teman sebaya saya
2. Potensi alam Kalimantan sangat baik daripada Jawa utk menunjang keperluan kegiatan kuliah saya.
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RIWAYAT PENDIDIKAN :
1. SD NEGERI BULAK LOR 2
2. SMP NEGERI 1 JATIBARANG
3. SMA NEGERI 1 JATIBARANG

.................... Public speaking 3........................................................................................................................................ ALASAN KENAPA BERGABUNG DENGAN KOPAJA ULM: 1............................. ..................................................................................................................................................................... ............................................................................................................................................................................................. Membentuk keluarga baru di Kalimantan 2......................................................................................................................................................................................................................... ........................................................................................................................................................................................................................ Menambah pengalaman .................................................................................................................................................. Snorkling dan Diving 2....................... ......................................... Memperkenalkan ULM ke Jawabarat ........................................................................................................................................................................................................................................................................................................................................................................ Bermanfaat bagi orang lain dan alam Kalimantan 3........................... APAKAH ANDA BISA BERMANFAAT UNTUK MASYARAKAT: SANGAT BISA!!! HOBY : 1....................................................................................................................................................................................................................... ............................................................................................................................FORMULIR PENDAFTARAN ANGGOTA BARU KOMUNITAS PELAJAR JABAR................................. KELEBIHAN YANG ANDA PUNYA : 1.......................................................................................................................................................................... ........................................... Menyanyi ........................................... .................................................................... ................................. ...................................... ................................................................................................................ ......... ..................................... ..................... Nanang Kota Banjarbaru 2017 4........................................................................................................................................................................................................................................................................................................... ................................................................................................................................. Ajang silaturahmi dengan KOPAJA 3.......... Kuliner 3............ TARGET SELAMA MENJADI MAHASISWA ULM: 1......................................................................................................... ............................................................... Menyanyi .................................................................................................. ................ .......................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................... .......................................................... ................................................. Loyal 2......................................................... Lulus paling lambat 4 tahun 2............................................................. ............................................................................ JABODETABEK ULM ............................... ...................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................... ....................................................................................................................... ............................................................................................................................................................................

....................................................... dan apabila dikemudian hari diketahui data/keterangan tersebut tidak benar........................................................................................................................ ....................................................................................................................................................................................................................................... ................................ ................................................................................................................................................................................................................................................................................................... ..................................................................................................................................................................................................................................................................................... .............................................................................................................................................................. ......................................................................FORMULIR PENDAFTARAN ANGGOTA BARU KOMUNITAS PELAJAR JABAR.................................................................................................................................................... 23 September 2016 (……………………......................................................................................................................................................................................................................................................................................................................................................................... maka saya bersedia menerima sangsi penghentian anggota.................. ...................................................................................................... ......................................................................................................... ................................................................................ Banjarbaru.............................................................................. JABODETABEK ULM DESKRIPSIKAN TENTANG ULM MENURUT PENDAPAT ANDA: ULM merukapan ptn tertua di Kalimantan.................................................................................................................................................................................................................................................................. ............................................................................................................................................................................................................................................. ................................................................................ ........................................................................................................................................................................................... Kesempatan untuk menonjol di sini sangat mudah.............................................. ................................. ................................................................. ....................................................................................................................) EEP SUHARTO *) Pengumpulan paling lambat tgl 23 September 2016 ....................................................................................................................................................................................................................................... ............................. Semua data/keterangan tersebut saya buat dengan jujur dan benar.......................... APAKAH ANDA BERMINAT DI BIDANG RISET TECHNOLOGY/RESEARCH: YA ................................ ....................... ...............................................................................................................