Confidential

Rahasia

BIODATA FORM
This form will be use for further employee master data
Please fill this form by using a type NOT hand writing (Mohon untuk mengisi form ini dengan diketik, TIDAK menggunakan tulisan tangan)

1. Personal Data Data Pribadi

==========================================================================================================================
*Filled by HR Division
Employee No.* 1571022706940021 Commencing Date* 3 0 - 1 2 - 2 0 2 2
NIK Tgl Masuk di Perusahaan d d m m y y y y
==========================================================================================================================
Title X Mr Mrs Ms Marital Status X Single Married Divorced Widower
Gelar Status

Name (as in ID) Zerri Date of Marital - -

Nama (sesuai KTP) Tanggal pernikahan D D M M Y Y Y Y

Date of birth 2 7 - 0 6 - 1 9 9 4 Religion Islam

Tanggal Lahir D D M M Y Y Y Y Agama

Place & Country of Birth Jambi Height/ Weight 1 6 4 cm 0 5 5 kg

Tempat Lahir Tinggi/ Berat badan

Nationality Indonesia Blood Type

Warga Negara Golongan Darah

Ethnic Group Melayu Social Media Nezer94

Suku Media Sosial
Nezer94
NPWP Number 60.792.720.9-335.000
No NPWP ( No Pajak)

2. Contact Details Detail Kontak

Email Address putrazerry715@gmail.com
Alamat Email

Permanent Address (as in ID) Alamat Tetap (sesuai KTP)

Street & House No. jl. R.B.Siagian, RT.01, Region/ Province Jambi
Jalan & Nomor Rumah Wilayah/ Propinsi

Kel.Talang Bakung,Kec.Paal Merah City Jambi

Kota/Kabupaten

Country & Postal Code Indonesia Districts Paal Merah

Negara Kecamatan

Telephone No. 82310904379 Sub - Districts Talang Bakung

No. Telephone Kelurahan

Current Address* Alamat Sekarang

*To be filled should current address is different from address stated in ID (Diisi jika alamat sekarang berbeda dengan alamat di KTP)

Street / House No. jl. R.B.Siagian, RT.01, Region/ Province Jambi

Jalan / Nomor Wilayah/ Propinsi

Kel.Talang Bakung,Kec.Paal Merah City Jambi

Kota/Kabupaten

Country & Postal Code Indonesia Districts Paal Merah

Negara Kecamatan

Telephone No. 82310904379 Sub - Districts Talang Bakung

No. Telephone Kelurahan

Emergency Address Alamat Darurat

Contact Person 85367402615

Street / House No. jl. R.B.Siagian, RT.01, Region/ Province Jambi

Jalan / Nomor Wilayah/ Propinsi

Kel.Talang Bakung,Kec.Paal Merah City Jambi

Kota/Kabupaten

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Corporate Human Resources
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Rahasia

BIODATA FORM
Country & Postal Code Indonesia Districts Paal Merah
Negara Kecamatan

Telephone No. 8537402615 Sub - Districts Talang Bakung

No. Telephone Kelurahan

3. ID Data Data Identitas

Place & Country of
Items Number Issue Date of Issue Valid to
Jenis Nomor Dikeluarkam di Tanggal Dikeluarkan Berlaku sampai dengan

ID Card 2 9 - 1 1 - 2 0 1 9 0 0 - 0 0 - 0 0 0 0
1.
(No KTP) 1571022706940021 Jambi D D M M Y Y Y Y D D M M Y Y Y Y

Passport - - - -
2.
(Passport) D D M M Y Y Y Y D D M M Y Y Y Y

Driving License Type 2 9 - 0 1 - 2 0 2 0 2 9 - 0 1 - 2 0 2 5

3 (Jenis Surat Izin Mengemudi) 2733-9406-000027 Jambi D D M M Y Y Y Y D D M M Y Y Y Y

A B1 B2

X C Others

4. Family Data Data Keluarga

Relationship Full Name Place of Birth Date of Birth Occupation Nationality
Hubungan Nama Lengkap Tempat Lahir Tanggal Lahir Pekerjaan Warga Negara

1. Father (Ayah) Darimi Pariaman 1 6 0 6 1 9 6 5 Perdagangan Indonesia

D D M M Y Y Y Y
2. Mother (Ibu) Raimah Pariaman 1 0 1 0 1 9 6 9 Perdagangan Indonesia
D D M M Y Y Y Y
Father-in-law
3.
(Ayah Mertua)
D D M M Y Y Y Y

4. Mother-in-law
(Ibu Mertua)
D D M M Y Y Y Y
Spouse
5
(Istri/ suami)
D D M M Y Y Y Y
6 Child (Anak)
D D M M Y Y Y Y

7 Child (Anak)
D D M M Y Y Y Y
8 Brother/ Sister Adinda Tri Ramadhanti Jambi 0 5 1 2 2 0 0 1 SLTA/Sederajat Indonesia
D D M M Y Y Y Y
9 Brother/ Sister

Please use this space for additional information for your family members
(Silahkan pergunakan tempat kosong di bawah untuk informasi tambahan anggota keluarga anda)

5. Previous Employers Riwayat Pekerjaan

Reason
Company Name Type Industry From - To (date) Reporting to Job/Position Country - City For Leaving
Nama Perusahaan Tipe Industry Dari-kapan Atasan Pekerjaan Negara- Kota Alasan keluar
*please choose one type industry

1. Hotel Ratu Hotel Swasta 2019 Akeng Room Boy Jambi Masih Bekerja

(pulp & paper, tissue, forestry,

2. others _____________________)

(pulp & paper, tissue, forestry,

3. others _____________________)

(pulp & paper, tissue, forestry,

4. others _____________________)

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Corporate Human Resources
 Confidential
Rahasia

BIODATA FORM
Job Description at last position
(Tanggung jawan pekerjaan di posisi terakhir)

6. Last Education Pendidikan Terakhir

School/College/University Degree Academic Title Major & GPA From - To (date)
Nama Sekolah Gelar Gelar Akademik Jurusan dan Nilai Mulai dari / sampai dengan
SMK PGRI Jambi Marketing 2 & 7,7 2010 - 2013

7. Training Pelatihan
Course Name Institution From - To (date)
Nama Pelatihan Penyelenggara Mulai dari / sampai dengan

1. PMI Palang Merah Indonesia 2009 - 2011

2. -

3. -

8. Skills Keterampilan
Languages (Bahasa) Indonesia & Sumatra Barat

Computer / Program (Komputer / Program) Microsoft Word

Others (Lain-lain)

9. Other Associations/Organizations Asosiasi/Organisasi Lainnya

Association/Organization Name From - To (date) Position Country
Nama Asosiasi / Organisasi Mulai dari / sampai dengan Posisi Negara
1. PMR 2007-Sekarang Pembina, Anggota,Pendiri Indonesia

2. Escorting 2019-Sekarang Pendiri, Anggota Indonesia

3. -

10. Others Lain-lain

1. Are you willing to be relocated X Yes No Tergantung Kebijakan Perusahaan
Bersediakah anda untuk di relokasi? If yes, please state you preffered location (Jika ya, tuliskan lokasi yang dikehendaki)

2. Are you willing working on shifts? X Yes No Lebih Suka Tukar Ganti Sift
Bersediakah Anda untuk bekerja dalam shifts? Please state reason (alasan)
* For certain area and locations

3. Do you own any vehicle? X Yes No Honda CBR 150cc

Apakah Anda memiliki kendaraan pribadi? If yes, please state type and year (jika ya, tulisan tipe dan tahun)

4. Have you ever suffered any serious illness/

have acccident history ? Yes X No
Apakah Anda pernah menderita penyakit berat/ memiliki If yes, please state what and when (jika ya, tuliskan penyakit dan kapan diderita)
riwayat kecelakaan?

*5. Do you have family/ relatives at Simas Jerry Sasmita, SHE HEAD OFFICER
Group/ APP ? X Yes No
Apakah Anda mempunyai keluarga/ kerabat di Grup Sinar Mas/ APP? If yes, please state detail : employee name, company and dept
(Jika ya, sebutkan nama, karyawan perusahaan, dan dept)

*6. Do you own or are part of ownership/ shareholder of any

X Yes No
companies or hold directorship or other external/ part time
employment of other than your current company discussed
during recruitment process? Berdagang dan Bantu Usaha Keluarga Page 3 / 5
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*6. Do you own or are part of ownership/ shareholder of any

companies or hold directorship or other external/ part time
BIODATA FORM
employment of other than your current company discussed
during recruitment process? Berdagang dan Bantu Usaha Keluarga
Apakah anda memiliki / menjadi bagian dari kepemilikan perusahaan If yes, please state % of ownership or directorship or employment position and name of the
atau memiliki jabatan directorship atau menjalani pekerjaan diluar/ company (Jika ya sebutkan % kepemilikan atau jabatan directorship atau pekerjaan
paruh waktu diluar pekerjaan anda saat ini? lainnya serta nama perusahaan)

*Note : If candidate state Yes on point 5 or 6, please consult with CRI Division

7. Have you ever followed the recruitment process in Yes X No

SiMas Group in the past?
Apakah Anda pernah mengikuti process di Grup Sinar Mas? If yes, please state when and what company (Jika ya sebutkan kapan dan perusahaan)
Dari Kakak Ipar
8. How do you know Sinar Mas Group?
Darimana Anda mengetahui mengenai Grup Sinar Mas?

9. Have you do your COVID 19 vaccination ? X Yes No Dosis 1, Udah Lupa

Apakah Anda sudah melakukan vaksinasi COVID 19 ? If yes, please state type and date of vaccionation (1st doses & 2nd doses)
(Jika ya, sebutkan jenis & tanggal pelaksanaan vaksin dosis 1 & 2)

10. Do you have any concern on COVID 19 If yes, please circle one of the reason below :
vaccination ? Yes X No
Comorbid/ Positive for COVID 19 below 90 days/ Allergic/ Others

Apakah anda memiliki kekhawatiran terhadap

vaksinasi COVID 19 ?

11. References Referensi

Name Company Phone Number Job/Position Relationship
Nama referensi Nama Perusahaan Nomor Telepon Pekerjaan Hubungan

1.

2.

3.

12. Closing Penutup

I hereby certify the information provided above is true. I understand that any misleading information provided in biodata form may result in
rejected application / termination of my employment.

Date - -
Tanggal D D M M Y Y Y Y Signature and Full Name
(Tanda Tangan dan Nama Lengkap)
Note:
For applicants; no salary, compensation or benefit is to be discussed during the interview. This process will be done by Compensation and Benefit
team of CHR APP. Thank you.

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Corporate Human Resources
 Form: 04/Biodata/CHR-PA/APP/Rev31052013

Confidential
Rahasia

BIODATA FORM (post hire) - to be filled by recruiter / C&B

14. Employment Data Data kepegawaian

To be filled should candidate is recruited (diisi jika kandidat direkrut)

Commencing Date - - Company Name

Tgl Masuk di Perusahaan D D M M Y Y Y Y Nama Perusahaan

Internal Level Title/Designation

Level Jabatan

Location Based Superior Name

Lokasi karyawan ditempatkan Nama Atasan

Phone Number and Ext Cost Center

Nomor Telepon dan Extention Cost Center

Emergency Contact Kontak Darurat yang bisa dihubungi

Name & Relationship Mobile Ph Number

Nama & Hubungan Nomor HP

Street / House No. Region

Jalan / Nomor Propinsi

Country & Postal Code

Negara

City Telephone No.

Kota/Kabupaten No. Telephone

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Corporate Human Resources