CONTRACTOR PERSONAL DATA

ID Number : Position No. : *)

Nomor karyawan Nomor Posisi

Former/Visitor ID : (For Ex-employee/Visitor – untuk mantan karyawan/Visitor

Nomo Karyawan / Visitor

A. PERSONAL INFORMATION
(to be filled by employee – Diisi oleh karyawan)

Full Name : PETRUS CHARLES MATURBONGS

Nama Lengkap
Preferred Name : PETRUS

Nama Panggilan
Home Address : TIMIKA
Alamat di luar jobsite

City/Kota : MIMIKA Post Code/Kode Pos :

State/Propinsi : PAPUA Phone/Telepon :

Date of Birth : 16 SEPTEMBER 1977 Place of Birth : LANGGUR

Tanggal Lahir DD / MM / YYYY Tempat Lahir

Gender
Kelamin
:  Male / Laki-Laki
Marital Status
Status perkawinan
:  Single / Lajang

 Female / Perempuan  Married / Menikah

Religion : KRISTEN KHATOLIK Date of Marriage :

Agama Tanggal pernikahan
DD / MM / YYYY

Citizenship : INDONESIA
Kewarganegaraan
KTP Number : 9109011609770005 Passport Number : -
Nomor KTP Nomor Paspor

JOB INFORMATION
(to be filled by company site administration or sponsored-Diisi oleh site Admin atau sponsor)

Company : CV.MIMIKA LESTARI Department : PT. AVCO

Perusahaan Departemen
Work Location : TIMIKA AIRPORT Job Title : DRIVER
Lokasi Kerja Pekerjaan
Mobilization Date : Work Phone # :
Tanggal Kedatangan di jobsite No. Telepon Kantor
Contract Number Contract End Date :
Nomor Kontrak DD / MM / YYYY Tanggal Akhir Kontrak DD / MM / YYYY

Supervisor : WEMPI JITMAU Onsite Address :

ID#/Name
ID#/Nama
Supervisor Alamat di Jobsite :
Point of Hire : TIMIKA
Tempat Penerimaan
Cost Center : Demobilization Date :
Tgnggal tiba di Jobsite DD / MM / YYYY

Employee Type
Golongan pekerja
:  Staff Onsite Status
Status di Jobsite
:  Single / Lajang
 Nonstaff  Married / Keluarga
Employee Class
Klasifikasi pekerja
:
 Permanent National/Expat :  National Papuan
 Temporary  National Non- Papuan
 Part-time  Expatriate
*) To be filled by PTFI HRD/Diisi oleh HRD PTFI
KPT & SIM B1 UMUM
ID VISITOR