PERSONAL DATA FORM

I. INDENTITAS DIRI

Nama Lengkap :
1.
(Full Name)
Tempat, Tanggal Lahir :
2.
(Place & Date of Birth)
Jenis Kelamin :
3.
(Gender)
Agama :
4.
(Religion)
Status Pernikahan :
5.
(Marriage Status)
6. Alamat Saat ini :
(Address)
Telephone / Hp / Email *Required :
7.
8. Departement / Company :
Alamat Perusahaan :
9.
(Company Address)

II. LINGKUNGAN KELUARGA

1. Susunan Keluarga (Istri / Suami dan anak-anak) *Family Structures (Wife, Husband and children)

Susunan Keluarga Nama L/P TTL Pendidikan Pekerjaan

(Family Structures) (Name) (Male / Female) (Date of Birth) (Education) (Job)
Suami / Istri
(Husband / Wife)
Anak 1
(1st Child)
Anak 2
(2nd Child)
Anak 3
(3rd Child)
Anak 4
(4th Child)

2. Susunan Keluarga Anda (Istri / Suami dan anak-anak) *Your Family Structures (Father, Mother, Brother, Sister,
include your self

Susunan Keluarga Nama L/P TTL Pendidikan Pekerjaan

(Family Structures) (Name) (Male / Female) (Date of Birth) (Education) (Job)
Ayah (Father)
Ibu (Mother)
Anak 1
(1st Brother / Sister)
Anak 2
(2nd Brother / Sister)
Anak 3
(3rd Brother / Sister)
Anak 4
(4th Brother / Sister)
Anak 5
(5th Brother / Sister)
RIWAYAT PENDIDIKAN *EDUCATIONAL BACKGROUND

Nama Sekolah Tempat Sekolah Jurusan Tahun Lulus

(School Name) (School Address) (Major) (Year of graduation)
University / Institut
SLTA

TRAINING / SEMINAR / PELATIHAN

RIWAYAT PEKERJAAN *JOB BACKGROUND

Uraikan secara singkat pekerjaan Anda selama ini (dimulai dari posisi terakhir) :
*Write a short description about your previous jobs

No. Jabatan Bln / Thn s/d Bln / Thn Perusahaan Bagian / Dept.
(Position) (Mon / Year - Mon / Year) (Company)
1.

2.

3.

4.

Sebutkan kelemahan dan kelebihan diri Anda :

*Mention your weakness and strength

Kelemahan (Weakness)

1. 2.
3. 4.

Kelebihan (Strenght)

1. 2.
3. 4.

Apakah yang Anda sukai dari pekerjaan Anda Sekarang (Kondisi, tugas-tugas, dsb.) Mengapa ?
*Do you have something you like from your current job, and why do you like it (office conditions, tasks,
facilitation)? If you do, explain it shortly.

Apakah yang Anda tidak sukai dari pekerjaan Anda Sekarang (Kondisi, tugas-tugas, dsb.) Mengapa ?
*Do you have something you do not like from your current job, and why (office conditions, tasks, facilitation)? If you
do, explain it shortly.

Yogyakarta,…………………..
(………………………….)