FP-DSDM01-01

REV.00
LAMARAN PEKERJAAN


PEKERJAAN YANG DILAMAR :


NAMA PELAMAR : 

TEMPAT / TANGGAL LAHIR : 
STATUS : Tidak Kawin / Kawin / Janda/ Duda*
JENIS KELAMIN : Laki-laki / Perempuan
AGAMA : 
TEMPAT TINGGAL/ALAMAT : 

NOMOR KTP : 
NOMOR TELEPON : 
PENDIDIKAN TERAKHIR :
(Tingkat/Bidang/Jurusan)

SPESIALISASI :

KEAHLIAN/KETRAMPILAN YANG :
SDR. ANGGAP PALING DIKUASAI PAS FOTO
TERBARU
BIDANG STUDI YANG PALING :
DISUKAI 3 x 4 cm
JUDUL SKRIPSI/PROYEK AKHIR :
KARYA TULIS

DIISI OLEH PERUSAHAAN

Catatan Wajib ;
(bila ada catatan khusus dan atau Tanggal wawancara :
calon pegawai hasil seleksi Pewawancara :
(psikotest/medical test) dinyatakan Keputusan : Diterima/ditolak/cadangan*
meragukan (tidak Ekstrim)
Tgl. Mulai bekerja :
khususnya dalam aspek-aspek yang
tidak terlalu penting. Status :Kontrak Kerja Biasa/Khusus*
Bila user tetap mau mencoba atau Golongan/pangkat :
dites ulang (dengan lembaga yang Jakarta, 20..
berbeda) dan diobservasi agar
dinayatakan / disebutkan dalam
kolom ini dengan jangka waktu
observasi selama 6 bulan..
Bila selama masa obervasi
SDM Unit :………….
menunjukan prilakuhasil kerja yang
tidak memuaskan maka kontrak Paraf
tidak diperpanjnag dan 1 bulan Paraf
sebelumnya ybs. diberitahu.

* Pilih salah satu ** Harap diisi dengan huruf cetak

Halaman 1
 FP-DSDM01-01
REV.00
LAMARAN PEKERJAAN

DATA KELUARGA

NAMA ISTRI / SUAMI TEMPAT / TGL. LAHIR PENDIDIKAN / PEKERJAAN

  

 

NO NAMA ANAK L/P TEMPAT/TGL. LAHIR PENDIDIKAN

1.    /  

2.    /  
3.    /  

NO NAMA ORANG TUA TGL. LAHIR PEND./PEKERJAAN ALAMAT

1.    

2.    

NO SAUDARA SEKANDUNG L/P TGL. LAHIR PENDIDIKAN / PEKERJAAN

1.    

2.    
3.    
4.    
5.    
6.    

KELUARGA ATAU KENALAN SDR. DI PT. SURVEYOR INDONESIA ATAU

DI DEPT. KEUANGAN
NO NAMA JABATAN INSTANSI HUBUNGAN

1.    

2.    

DATA PRIBADI

Tinggi Badan :  cm. Berat Badan :  Kg.

Kegemaran / Hobby :
Macam kegiatan olah raga yang dikuasai :
Pernah sakit keras : ya/tidak* kapan : …
sakit apa : 
Pernah mendapat kecelakaan : ya/tidak* kapan : 
kecelakaan apa : 
akibat kecelakaan : 
Pernah terlibat kegiatan terlarang : ya/tidak;*
Pernah tersangkut urusan dengan pihak kepolisian : ya / tidak*
Jelaskan
: 

Pernah terdaftar sebagai peserta/anggota program ASTEK: ya/tidak;*
No. Peserta/KPA : 
Pernah mengikuti Penataran P4 : ya/tidak;* kapan : .
Pola/Type : 
Penyelenggara : 

Halaman 2
 FP-DSDM01-01
REV.00
LAMARAN PEKERJAAN

DATA PRIBADI (lanjutan)

KECAKAPAN BAHASA (sebutkan
aktif/pasif ) :
1.  3. 
2.  4. 
SURAT IZIN MENGEMUDI :
RIWAYAT HIDUP

SEKOLAH-SEKOLAH
NAMA SEKOLAH TEMPAT/KOTA SAMPAI KLS DARI/SAMPAI TH JURUSAN TH.
IJAZAH

1.      

2.      
3. …     
    
4. …
    
5. 

KURSUS-KURSUS
MACAM - KURSUS LAMA KURSUS DARI/SAMPAI SERTIFIKAT/KET.
TGL,BLN,TAHUN

1.    

2.    
3.    
4.    
5.    

PENGALAMAN KERJA
INSTANSI/ JABATAN DARI-s/d FASIITAS ALASAN
PERUSAHAAN TGL,BLN,TH BERHENTI
GAJI TUNJANGAN
   -    
   -    
   -    
   -    
   -    
   -    

PENGALAMAN DI LUAR NEGERI

DARI / SAMPAI TH. NEGARA TUJUAN / KETERANGAN
 -   
 -   
 -   

Referensi / Keterangan mengenal pengalaman kerja dapat diminta kepada :

NO. NAMA ALAMAT & NO. TELEPON JABATAN HUBUNGAN
1.    
2.    



Halaman 3
 FP-DSDM01-01
REV.00
LAMARAN PEKERJAAN

RIWAYAT HIDUP (lanjutan)

PENGALAMAN BERORGANISASI
NO. NAMA ORGANISASI/PERKUMPULAN DI SEBAGAI

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2
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KETERANGAN LAIN-LAIN

Tunjangan / fasilitas yang diterima sekarang dan sumber pendapatan yang lain :
…………………………………………………………………………………………………………………..
Gaji dan fasilitas / tunjangan yang diharap :……………………………………………………….

Bersedia ditempatkan dimana saja di seluruh wilayah operasi perusahaan : YA/TIDAK*

Bersedia mematuhi segala peraturan perusahaan yang berlaku maupun

yang akan dikeluarkan oleh perusahaan : YA/ TIDAK*

Keterangan lain yang ingin Saudara kemukakan :

Pernyataan
Yang bertanda tangan di bawah ini menerangkan bahwa ;

1. Keterangan yang ditulis tersebut di atas diberikan dengan sebenarnya dan dengan penuh
kesadaran.
2. Apabila saya diterima sebagai pegawai PT Surveyor Indonesia, maka saya sudah tidak
terikat hubungan kerja dengan instansi / lembaga lain / pihak ketiga.
3. Apabila keterangan tersebut diatas ternyata mengandung keterangan yang tidak benar,
maka saya bersedia menanggung semua akibatnya dan saya bersedia menerima
keputusan apapun dari perusahaan termasuk pemutusan hubungan kerja tanpa ada ganti
kerugian dalam bentuk apapun juga.
,   
Tanda tangan pelamar,

(  )

Halaman 4