You are on page 1of 2

ISMM Departmental Questionnaire

Personal information
Surname/Family name First name
Herdianto Bachtiar

Date of birth Nationality/Citizenship

2 November 1993 Indonesian

Permanent address Current address

RT/RW:13/03, Tawangrejo, Takeran. RT/RW:13/03, Tawangrejo, Takeran.
Magetan. East Java. Magetan. East Java.
Indonesia Indonesia
Postcode: 63381 Postcode: 63381

Email address valid until start of course Mobile number including country code
+62 82234569610

Academic details
High School attended with dates A2 subjects (UK educated) with grades or equivalent

University/College attended with dates Title of Degree Type of Degree Final result
Bachelor of Engineering (BSc, MEng etc) 3.71 / 4.0
Department of Industrial Engineering,
Faculty of Engineering,
Universitas Brawijaya Year 1 grade Year 2 grade Year 3 grade Year 4 grade
(% or GPA) (% or GPA) (% or GPA) (% or GPA)
3.73 / 4.0 3.85 / 4.0 3.75 / 4.0 3.71 / 4.0

Work experience
Please give brief details of any paid or unpaid employment, including charity work (continue on separate sheet if necessary)
Employer Location Job title Job description/duration/date
PT. Indonesia Epson Industry East Jakarta Industrial Park Manufacturing Engineering I Have main responsibilities
(EJIP) Plot 4E, Bekasi, Staf to design assembly process
Indonesia and assembly layout for
Inject Printer and Scanner.
Also, I have responsibilities to
investigate production
problem related line
balancing, ergonomic
assembly, and production
productivity and develop
project plan for
improvement. Further, I also
develop and implement
production equipment to
reduce 3M (Muri, Mura, and
Muda). / Duration: 3 years /
11 July 2016 until now.
In not more than 200 words explain how your work experience has helped to define your intended career direction

Future career plans

English Language scores obtained IELTS/TOEFL (where applicable)

Year taken Scores
- -

Any other language capability

Bahasa Indonesia (Native)

Additional personal information indicating any positions of responsibility & level of achievement (where applicable)
Membership of any clubs
or societies

Sporting interests

Any other hobbies or


Practical experience or activities during summer vacations (where applicable)

Application information
Dates when you are unavailable for interview

Other applications being made:

This form should be completed as part of your application documents