PT XYZ

OFFSHORE NEW PERSONNEL REGISTRATION FOR

FORMULIR PENDAFTARAN PERSONAL BARU

Registered By :

PERSONNEL INFORMATION Always use softc

First Name * :
Nama Depan
Surname * :
Nama Belakang
Middle Initial * :
Nama Tengah

Date of Birth * : -- -- (In format ddmmyyyy)

Tanggal Lahir (dalam format hhbbtttt)
Marital Status :
Status Pernikahan Choose One Status : Married, Single, Cohabiter or Unknown

Company Name * :
Nama Perusahaan
Position * :
Posisi

Supervisor/Contract Owner * :
User Name di MedcoEnergi
Work Location * :
Lokasi Kerja Choose One Status : Belida/Hangtuah/Intan/Belanak/Kerisi/North Belut/Gas Conc

Work Period Start * : -- -- (In format ddmmyyyy)

(dalam format hhbbtttt)
Work Period End * : -- -- (In format ddmmyyyy)
(dalam format hhbbtttt)

Company ID Number :
Nomor Identitas Karyawan
Nationality * :
Kewarganegaraan
Phone Number :
Nomor Telepon
Email Address :
Alamat Email

Home Address :
Alamat Rumah
EMERGENCY CONTACT INFORMATION

First Name :
Nama Depan
Surname :
Nama Belakang
Middle Initial :
Nama Tengah
Phone Number :
Nomor Telepon
Relational : (Father, Mother, Spouse, etc)
Status Hubungan (Ayah, Ibu, Suami, dll)

see next page →

Remarks : * mandatory fields, must be filled prior to check-in process

Keterangan * informasi wajib yang harus diisi sebelum melanjutkan proses check-in
* Scan your Identity Card is a mandatory to be included in this form with condition :
* Picture is a mandatory to be included in this form with condition :
* (Foto wajib di sertakan dalam formulir ini dengan syarat : )
a. Minimum Picture quality is 300pixels (Kualitas minimal foto mengandung 300pixel)
b. 500kb maximum picture file size (Maksimal ukuran file foto adalah 500kb)
c. Image must be in .jpg, .gif or .png - format (Foto harus menggunakan format .jpg, .gif atau .png)

*Scan Identity card also a Mandatory Field *Picture also a Manda

Picture
Hereby, I sign this registration form with my fully understanding and the data is valid.
Dengan ini saya menandatangani lembar registrasi ini dengan pemahanan penuh dan data yang benar.

(Plase state your full name)

(Mohon cantumkan nama lengkap)
ISTRATION FORM
N PERSONAL BARU

Date : dd / mm / yyyy

Always use softcopy (gunakan selalu softcopy)

Gender * : F = Female, M = Male

Jenis Kelamin F = Wanita, M = Pria

wn

si/North Belut/Gas Concord.

(If possible enter the cell phone number)

(Jika memungkinkan, masukkan nomor telepon selular)
 (If possible enter the cell phone number)
(Jika memungkinkan, masukkan nomor telepon selular)

, .gif atau .png)

*Picture also a Mandatory Field

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