No Dokumen WP-F-HRD-01/08

PERSONAL DATA Tanggal Terbit 03 November 2014

PT WIJAYA PURA Revisi 00

PERSONNEL QUESTIONNAIRES

I. GENERAL DATA

A. PERSONAL DATA

1. Name & Surname : ...............................................................................

2. Address : ...............................................................................
...............................................................................
Phone : ........................ (Res) ..................... (Mobile)

3. Place & Date of Birth : ...............................................................................

4. Marital Status : _____________ Single ___________ Married

5. Religion : ...............................................................................

6. ID No. : ...............................................................................

7. Interests : ...............................................................................

7
7 B. RELATIVES

1. Name of Spouse : ...............................................................................

2. Place & Date of Birth : ...............................................................................

3. Address : ...............................................................................
...............................................................................
Phone : ........................ (Res) ..................... (Mobile)

4. Occupation : ...............................................................................

5. Address / Tel. No.

of Company : ...............................................................................
...............................................................................

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 No Dokumen WP-F-HRD-01/08

PERSONAL DATA Tanggal Terbit 03 November 2014

PT WIJAYA PURA Revisi 00

6. No. of Children : ...............................................................................

No. Name Place & Date of Birth

No. Name of Parents, Sisters & Brothers Address

II. EDUCATION

A. FORMAL EDUCATION

Start - Finish Name & Address of School Results /

Certificates

B. INFORMAL EDUCATION

Start - Finish Course / Seminar / Workshop / Training etc. Certificate

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 No Dokumen WP-F-HRD-01/08

PERSONAL DATA Tanggal Terbit 03 November 2014

PT WIJAYA PURA Revisi 00

C. LANGUAGE Active Fair Passive





D. ADDITIONAL SKILLS Yes No

1. Computer Literate
(Please describe the Program)

..........................................................................................
..........................................................................................
..........................................................................................

2. Others
(Please describe)

..........................................................................................
..........................................................................................
..........................................................................................

III. WORKING EXPERIENCE

A. WORKING EXPERIENCE

Start - End Name & Address of Company / Organization Position

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 No Dokumen WP-F-HRD-01/08

PERSONAL DATA Tanggal Terbit 03 November 2014

PT WIJAYA PURA Revisi 00

B. INCOME & BENEFITS

Previous Expected

 Monthly Salary
 Bonus
 Benefits
 Others

IV. STATE OF HEALTH

1. Psychology Test : __________ Yes __________ No
Please describe (when, where & result)

.....................................................................................................................
.....................................................................................................................

2. Medical Check Up : __________ Yes __________ No

Please describe (when, where & result)

.....................................................................................................................
.....................................................................................................................

3. Physical Infirmity : __________ Yes __________ No

Please describe

.....................................................................................................................
.....................................................................................................................

4. Health Insurance : __________ Yes __________ No

By

.....................................................................................................................
.....................................................................................................................
.....................................................................................................................

V. REFERENCES

Name Position Company Name & Address Telephone

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