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(Form) Personnel Record JO - r3

This document contains personnel records and personal information for an employee, including their full name, photo, nationality, identity number, date and place of birth, contact details, family details, education history, employment history, emergency contacts, and a declaration of truth. It collects information across multiple areas to fully document an individual's records for employment purposes.

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kbatsen
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18 views3 pages

(Form) Personnel Record JO - r3

This document contains personnel records and personal information for an employee, including their full name, photo, nationality, identity number, date and place of birth, contact details, family details, education history, employment history, emergency contacts, and a declaration of truth. It collects information across multiple areas to fully document an individual's records for employment purposes.

Uploaded by

kbatsen
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as XLSX, PDF, TXT or read online on Scribd
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Personnel Records Photo

Personal Information
Full Name / Nama Lengkap

Nick Name / Panggilan Nationality / Kebangsaan

NIK / Identity Number Sex / Jenis Kelamin Male Female

Place & Date of Birth / TTL

Size of Uniform / Ukuran Baju

Safety Shoes Size / Ukuran Sepatu

Religion / Agama
Covid-19 Vaccination/ 1st Dosage (Tanggal dan Jenis Vaksin)
Vaksinasi Covid-19
2nd Dosage (Tanggal dan Jenis Vaksin)

Booster (Tanggal dan Jenis Vaksin)


Current Address / Alamat Domisili Street

City / Regency
Address (based on ID Card) / Alamat Street
sesuai KTP
City / Regency
Contact Information / Nomor HP dan Phone 1
Email aktif
Phone 2 E-Mail Address

Educational & Employment History


Educational Background/ Name of the University / School

Pendidikan Terakhir Major or Specialty

Period From End

Academic Degree Acquired

Last Job Career/ Company

Pekerjaan Terakhir Period Position

Family Information
Marriage Status/ Status Pernikahan
Single Married Divorced

Parents/ Orang Tua No Name Status Age Profession

1 Father

2 Mother

Spouse/ Istri/Suami No Name Status Age Profession


1
Children/ Anak No Name Status Age Profession

Other
Family Card Number/ No. KK

Bank Account Number Bank

BPJS Kesehatan BPJS Jamsostek

NPWP

Emergency Contact
Name / Nama Kontak Emergency Relationship
(Saudara/ Keluarga/ Kerabat dekat)
Address
Contact Information/ Nomor Kontak Phone 1
Emergency (Saudara/ Keluarga/
Kerabat dekat) Phone 2 E-Mail Address

Hereby I declare that all information above are truth

Balikpapan / ……………….. 2023

(__________________________)

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