Personal Profile

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PERSONAL PROFILE FORM

DATA KARYAWAN
A. Personal
Data Pribadi

1 Employee No.
Nr.Induk Pegawai
2 Full Name
Nama Lengkap
3 Date of Birth
Tgl.Lahir
4 Place of Birth
Tempat Lahir
5 NPWP No.
(Nomer Peserta Wajib Pajak)
6 KTP / Passport No.
7 Sex Male/Pria Female/Wanita
Jenis Kelamin
8 Marital Status Single/Blm nikah Married/Nikah Single Parents/Janda-Duda
Status Perkawinan
9 Religion
Agama
10 Nationality
Kebangsaan
11 Jamsostek No.
Nomor Jamsostek
12 Correspondence address
Alamat surat

Post Code / Kode Pos


13 Permanent Address
(according to KTP)
Alamat tetap (sesuai KTP)

Post Code / Kode Pos


14 Telephone No / HP No.
No.Telepon/ No.HP
15 Private Email
Email Pribadi
16 Mother’s Name
Nama Ibu Kandung
B. Job Data (diisi oleh HRD / filled in by HRD)
Data Pekerjaan

1 Location Type
2 Dept. Company Group (MTI / KRI / SWD / SRI)
3 Section
4 Title
5 Position
6 Employment Mode
7 Employement Category  Probation  Permanent  Contractual
 Trainee  Part Timer

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8 Payroll Group
9 Grade
10 Employment Group
11 Legal
12 Immediate Superior
Atasan Langsung
13 Join Date (dd/mm/yy)
Tanggal mulai bekerja

C. Payroll
Data Pembayaran Gaji

1 Bank Name
Nama Bank
2 Bank Address
Alamat Bank
3 Bank A/C No.
No.Rekening
4 Account Holder
Pemilik Rekening

D. Family Details 3
Data Keluarga

1 Spouse Name 4

Nama Suami/Istri
2 Date of Birth (dd/mm/yy)
Tgl.Lahir
3 Date of Marriage
Tgl.Menikah
4 Sex / Jenis Kelamin Male/Pria Female/Wanita
5 Nationality
Kebangsaan
6 Occupation
Pekerjaan

1 Children 1st Name 4

Nama Anak Pertama


2 Sex / Jenis Kelamin Male/Pria Female/Wanita
3 Date of Birth (dd/mm/yy)
Tgl.Lahir
4 Occupation
Pekerjaan

1 Children 2nd Name 4

Nama Anak Kedua


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2 Sex / Jenis Kelamin Male/Pria Female/Wanita
3 Date of Birth (dd/mm/yy)
Tgl.Lahir
4 Occupation
Pekerjaan

1 Children 3rd Name 4

Nama Anak Ketiga


2 Sex / Jenis Kelamin Male/Pria Female/Wanita
3 Date of Birth (dd/mm/yy)
Tgl.Lahir
4 Occupation
Pekerjaan

E. Education (starting from high school)


Pendidikan (dimulai dari Sekolah Lanjutan Tingkat Atas)

Type of Name of School / Major in Period Place Graduated


Education University Waktu Belajar Tempat Lulus/Berijazah
Jenis Pendidikan Nama Sekolah/Kejuruan di Universitas
SLTA
D1
D2
D3
S1
S2
S3

F. Job History (starting from last experience)


Riwayat Pekerjaan (dimulai dari pengalaman kerja terakhir)

Name of Institution Position Period (mm/yr) Reason for leaving


Nama Perusahaan Jabatan Jangka Waktu Alasan Berhenti
(bln/thn)

G. Additional Training
(Pelatihan Tambahan)

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Type of Training Name of Institution Period (mm/year) Place
Jenis Pelatihan Nama Penyelenggara Waktu Pelatihan Tempat
(bln/thn)

H. Foreign Languages
Kemampuan Bahasa asing
(Please put remark, e.g : Passive, fair, fluent / beri catatan : pasif, cukup, lancar)
Language Oral Written Reading
Jenis Bahasa Berbicara Menulis Membaca

Person to be contacted in case of emergency


Nama orang yang harus dihubungi dalam keadaan mendesak

Name Address Telephone


Nama Alamat Telepon

I DECLARE THAT ABOVE DATA ARE COMPLETE AND TRUE


Saya menyatakan bahwa data tersebut di atas adalah benar

JAKARTA,___________________ ______________________
Signature/tanda tangan

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