PERSONAL DATA SHEET

TOYO-ADHI-WAKACHIKU JOINT VENTURE

PATIMBAN PORT DEVELOPMENT PROJECT (1)
Package 2: Breakwater, Seawall and Channel Dredging Works

LEMBAR DATA PRIBADI/PERSONIL DATA SHEET

DAFTAR PRIBADI KARYAWAN (PERSONAL INFORMATION)
Nama
Name :
Tanggal lahir Gol. Darah
Date of birth : Blood type :
Alamat Jenis kelamin
Address : Gender :
No. handphone No. KTP
Phone number : ID card number :
E-mail
E-mail :
INFORMASI PEKERJAAN (JOB INFORMATION)
Jabatan Perusahaan
Position : Company name :

Mulai bekerja ID Karyawan

Start date : Employee ID :

INFORMASI KONTAK DARURAT (EMERGENCY CONTACT INFORMATION)

Nama Hubungan
Name : Relationship :

No. handphone
Phone number :

KUALIFIKASI (QUALIFICATION)

Captain Mechanical Lisensi sertifikat/pengemudi no./certificate/driving license no.

- Technician
- Expert
Electrician
- Technician
- Expert
Rigger
Crane Operator
Mobil crane operator
Excavator operator
Vibro Roller
Operator Buldozer
operator Carpenter
Truck/dump truck driver
Welder
- Level I
- Level II
- Level III
Occupational Safety and Helth
- General
- Construction
- Junior Expert
- Intermediate expert
- Principal
expert Other

................, ..................................20...........

Nama, tanda tangan karyawan

Empoyee's name and sign
*Harap berikan salinan sertifikat dan SIM seperti yang disebutkan
diatas Lampirkan 1. Foto copy KTP/SIM
2. Foto copy SIO (operator alat berat)
3. Foto copy sertifikat kompetensi lain yang dimiliki (scaffolder/electrical/rigging/first aid, dll)