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PENDAFTARAN SISWA LPK AMANAH
Alamat :
Perumahan Bumi Sampang Baru Karang Tengah Cilacap Ruko B1 B2 Sebelah Timur RS Pricilla Sampang, Kelurahan Karangtengah, Kec. Sampang, Kab. Cilacap, Jawa Tengah 53273
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NAMA
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JENIS KELAMIN
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LAKI-LAKI
PEREMPUAN
GOLONGAN DARAH
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ALAMAT
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SESUAI KTP
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AGAMA
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HURUF KAPITAL
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STATUS PERNIKAHAN
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TINGGI BADAN
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BERAT BADAN
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Email
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NO. HP
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NO. DARURAT (ORANG TUA/WALI)
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TANGAN DOMINAN
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KANAN
KIRI
MATA MINUS
BERI KETERANGAN
KANAN : -2 CYLINDER : 0,5
KIRI : -2,5 CYLINDER : 0,5
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APAKAH MEROKOK
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Ya
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APAKAH ALKOHOL
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Ya
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APAKAH MEMILIKI TATTO
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Ya
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APAKAH MEMILIKI TINDIK
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Ya
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RIWAYAT PENDIDIKAN (SD)
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CONTOH : SD N 1 PURWOKERTO (2010-2016)
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RIWAYAT PENDIDIKAN (SMP)
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CONTOH : SMP N 1 PURWOKERTO (2010-2016)
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RIWAYAT PENDIDIKAN (SMA/SMK)
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CONTOH : SMA N 1 PURWOKERTO (2010-2016)
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JURUSAN SMA/SMK
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KULIAH
CONTOH : UNIVERSITAS INDONESIA (2010-2016)
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JURUSAN KULIAH
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RIWAYAT PEKERJAAN – JENIS PEKERJAAN
CONTOH :
PT. MPM Motor (2020-2023) – MARKETING
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