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Request Date
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pu[P ard Papor Fo{hJcts
App-cn n-acA-o2-FoRM-o I
EXTERNAL TRAINING FORM
Trainee Data
n 4 1
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0 4 Division: HR&EM
Employee SAP/ID 1 1

Cost Center 2 2 0 0
Full Name ANANG KURNIAWAN
E Department HR&EM
pany KKM CKR Ext 1 1

Cost Center 2 2 0 U

Level/Position 6 / Specialist SafetY

Traini Program
Training Provider
/Organizer
Training sKP Ahri K3 umum
ining Date up to
dd ddmmyyyy
Phone/Fax
(Training Location)

ing Objective (Must be fit led)

kti seseora ng m njadi Ah
(Perm enaker) No 2 T ah un 1 992 d ibutuh kan Bu
Sesuai Peratu ran Menteri Ketenagake rjaan
mempunya dokumen atau Surat
atan dan atan di perusahaan

'ahun (KKM Cikara ng peralihan kepada person Ah K3 baru

u selam a T
[Vlenteri Ketenagakerjaan yang be rlak

Reason for Traini tick "X'n

Cost Saving System lmprovement tr Job Effectiveness l-lot"t..

or and or outcome the

current or
for the train ram
kills or behavior that are
To Be
As ls
mengawasi
person Ahli K3 Um u m Baru Diharapkan personil yang tunjuk dapat
KKM Cikarang saat tnl m emili 1

U g-undang
d
de ngan ba ik
serta dapat meng m plementasi kan SMK3

8U.17
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Date
Date
Telo S out" 0'? ffi | zt
17 Head
HR Head

Date
Date

CHRO
AcademY

Date
Date

Notes
1. This form is onlY applicable AI @ne) training Event
Please attached the training brochures
(ext. 2052) Serpong Office at leasf 10
(ten) wofiing days betorc the training date.
J Please return this training form to Agnes days.
can be returned within 5 working
4. lf the training be reimbursed the registration form