PT.

CBC PRIMA
Midplaza 2 Building, 12th Floor
Jl. Jend Sudirman Kav.10-11, Jakarta Pusat 1
Tel: (62)21-570-7590 Fax: (62)21-570-7591

EMPLOYEE DATA

Full Name :
Join Date :
Probation period :
Permanent date :
Position :
Division :

Personal Information
Place, Date of Birth :
Id number (KTP) : Valid through :
Jamsostek / BPJS Ketenagakerjaan No. : Registered on :
NPWP No. : Registered on :
JSHK No. : Registered on :
Address :

Phone number : 1. (62)

2. (62)
Gender :
Blood Type :
Religion :
Marital status :
(If married)
Wife/Husband name : F/M Date of birth:
Children name : 1. F/M Date of birth:
2. F/M Date of birth:
3. F/M Date of birth:
Last formal education :

Institute / University Field of Study Major Period

List of family member: Parents & siblings (including employee)

Name Relationship Date of birth Occupation
Contact person for emergency call (not live in the same address)
1) Name : 2) Name :
Relationship : Relationship :
Phone Number : Phone Number :
12th Floor
10-11, Jakarta Pusat 10220
Fax: (62)21-570-7591

Note

Address