APL.01.

ASESSMENT REGISTRATION FORM

1 : Personal Data

Fill it include personal data, the data of formal education as well as the data of your current
work .

a. Personal Data
Name :

Date & Birth Place. :

Gender : Male/Female *

Nationality :

Address :

Post Code :

Telepon/E-mail : Home : Office :

PH : E-mail :

Education :

b. Current Position

Industry Name :

Position :

Address :

Pos Code :

Telp/Fax/E-mail : Telp : Fax :

E-mail :

KOMISI SERTIFIKASI BNSP-IA/2015 FORM APL-01-Rev.02

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2 : Unit Competecy
The Unit Competencies requirement

Certification scheme :
Job Index Number :

Core and Generic Competencies

International
No. Unit Code Unit Title
Standard
1 ACCSTP
2 ACCSTP
3 ACCSTP
4 ACCSTP
5 ACCSTP
6 ACCSTP
7 ACCSTP
8 ACCSTP
9 ACCSTP
10 ACCSTP

Functional Competencies
11 ACCSTP

12 ACCSTP

13 ACCSTP

14 ACCSTP

KOMISI SERTIFIKASI BNSP-IA/2015 FORM APL-01-Rev.02

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3 : The Document

Availabl
e
N
o Basic evidence Unavailable
. Qualified Unqualified

1 ☐ ☐
.
2 ☐ ☐
.

3 ☐ ☐
.

Recommendation : Candidate :

Name
Based on above evidence, the candidate
*accepted / not yet accepted as an assesse
Signaturte/
Date
*choose one

Remark : Assessor :
Name
No. Reg.

Signature/
Date

KOMISI SERTIFIKASI BNSP-IA/2015 FORM APL-01-Rev.02

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