FORMULIR PENDAFTARAN SR 2017

FORMULIR PENDAFTARAN
CALON SENIOR RESIDENT 2017 / 2018
ASRAMA PROGRAM PENDIDIKAN KOMPETENSI UMUM

FORMULIR PENDAFTARAN
Biodata Singkat
Nama Lengkap
Nama Panggilan
Fakultas
Departemen, Angk
NIM

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IPK

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CITA - CITA
1 tahun kedepan
5 tahun kedepan
10 tahun kedepan

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KOMPETENSI YANG DIMILIKI*
( ) Manajemen SDM
( )
( ) Administrasi
( )
( ) Public Speaking
( )
( ) Event Organizer
( )
( ) Penguasaan Bahasa asing ( )

Karya Ilmiah
Desain Grafis
Broadcasting
Fotografi
Gardening

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Entrepreneurship

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*Beri tanda centang untuk kompetensi yang dikuasai.
Sebut dan ceritakan satu masalah terberat yang pernah dihadapi serta tindakan yang Anda
lakukan untuk mengatasinya saat itu!
a. Saat SMA
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b. Saat PPKU
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Alasan Anda layak bergabung dalam Senior Resident Asrama PPKU IPB 2016/2017
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CURRICULUM VITAE
CALON SENIOR RESIDENT 2017 / 2018

Biodata

Nama lengkap
Nama panggilan
Jenis kelamin
Tempat, tanggal lahir
Agama
Alamat rumah
Alamat kost
No.Telp/HP
Email
Golongan Darah
Hobi
Motto

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Biodata Orang Tua
Nama

Pekerjaan

No HP

Ayah
Ibu

Riwayat Pendidikan
a. Formal
No.

Jenjang Pendidikan

Nama Institusi Pendidikan

Tahun

Nama Institusi Pendidikan

Tahun

b. Non-formal
No.

Jenis Pendidikan

Riwayat Pengalaman Organisasi
No.

Nama Organisasi

Jabatan/peran dalam Organisasi

Tahun

Jabatan/peran dalam Kepanitiaan

Tahun

peran dalam Kegiatan

Tahun

Riwayat Pengalaman Kepanitiaan
No.

Nama Kepanitiaan

Riwayat Pengalaman Lain - lain
No.

Nama Kepanitiaan

*Contoh: pembicara, MC/moderator, trainer, relawan, dan lain sebagainya.
Prestasi
a. Akademis
No.

Acara

Prestasi yang diraih

Acara

Prestasi yang diraih

Tahun

b. Non-akademis
No.

Tahun

Saya yang mencantumkan nama dibawah ini menyatakan bahwa tidak ada rekayasa
dalam pengisian data dalam CV ini. Saya telah mencantumkan data tersebut dengan sebenarbenarnya dan sejujur-jujurnya.
Bogor, ….. Juni 2017

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