Confidential

Rahasia v4.0

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.* 1408041002920001 Commencing Date*

NIK* Tgl Masuk D D - M M - Y Y Y Y
============================================================================================================================= =

Title* ✔ Mr Mrs Ms Marital Status* Single ✔ Married Divorced Widower

Gelar Status

Date of Marital 16-05-2022

Name (as in ID)* Stefanus Yasama Gea
Nama (sesuai KTP) Tanggal pernikahan D D - M M - Y Y Y Y

Date of birth* 10-02-1992 Religion Kristen

Tanggal Lahir D D - M M - Y Y Y Y Agama

Place & Country of Birth Onowaembo Esiwa Height/ Weight 167 Cm 68 kg

Tempat Lahir Tinggi/ Berat badan

Nationality Indonesian Blood Type - Please Select -

Warga Negara Golongan Darah

Stefan Ghea
Ethnic Group Nias Social Media
Suku Media Sosial

NPWP Number Payee Name Sinarmas

62.950.170.1-222.000 Stefanus Yasama Gea
No NPWP (No Pajak) Nama sesuai rekening Bank Sinarmas
BPJS Number 21051883250 Account Number Sinarmas 0056924318
No Jamsostek(BPJS Ketenagakerjaan) Nomer rekening Bank Sinarmas

2. Contact Details Detail Kontak

Email Address Stefangea44@gmail.com
Alamat Email

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

Street & House No. Region/ Province

Jln. Pertiwi Blok D RT. 001/002 - Riau
Jalan & Nomor Rumah Wilayah/ Propinsi

2nd Line Address City Siak

Alamat Baris ke-2 Kota/Kabupaten

Country & Postal Code Districts

Indonesia 28772 Tualang
Negara Kecamatan

Telephone No. Sub - Districts

62 882 7142 7738 Pinang Sebatang Timur
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. Jln. Mess Supir Dusun Suka Melati Region/ Province
- Riau
Jalan / Nomor Wilayah/ Propinsi

2nd Line Address City Siak

Alamat Baris ke-2 Kota/Kabupaten

Country & Postal Code Districts Tualang

Negara
Indonesia 28772 Kecamatan

Telephone No. Sub - Districts Pinang Sebatang Barat

No. Telephone
62 882 7142 7738 Kelurahan

Emergency Address Alamat Darurat

Contact Person

Street / House No. Region/ Province - Please Select -

Jalan / Nomor Wilayah/ Propinsi

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BIODATA FORM
2nd Line Address City
Alamat Baris ke-2 Kota/Kabupaten

Country & Postal Code Districts

Negara
Indonesia 99999 Kecamatan

Telephone No. 62 Sub - Districts

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

1 ID Card
(No KTP) 1408041002920001 Indonesia 14-09-2022 Seumur Hidup

D D- M M- Y Y Y Y D D- M M- Y Y Y Y
2 Passport
(Passport)
Indonesia
3 Driving License Type D D- M M- Y Y Y Y D D- M M- Y Y Y Y
(Jenis Surat Izin Mengemudi)
A
0929-9202-000045
Indonesia 14-01-2026
4 Driving License Type
Jenis Surat Izin Mengemudi) D D- M M- Y Y Y Y D D- M M- Y Y Y Y

Indonesia
D D- M M- Y Y Y Y D D- M M- Y Y Y Y

4. Family Data Data Keluarga

Relationship Full Name Place of Birth Date of Birth Occupation Nationality
Hubungan Nama Lengkap Tempat Lahir Tanggal Lahir (dd-mm-yyyy) Pekerjaan Warga Negara

Ingati Gea (Alm) Nias 25-12-1965 Indonesian

1. Father (Ayah)

2. Mother (Ibu) Lisamani Zalukhu Nias 15-02-1970 Ibu Rumah Tangga Indonesian

Father-in-law
3. Maruhum Hutagalung Tarutung 07-11-1964 Petani Indonesian
(Ayah Mertua)

Mother-in-law
4.
(Ibu Mertua) Rusmala Manurung Siantar 25-05-1972 Petani Indonesian

5. Spouse
(Istri/ suami) Sarma Dwi ladi Hutagalung Jakarta 14-04-1998 Buruh Swasta Indonesian

6 Son Indonesian

7 Son Indonesian

Son Indonesian
8

Brother Indonesian
9

Tax Exemption Status 1408040909220004

Tidak Ada Tanggungan No Kartu Keluarga
(Jumlah Tanggungan Penghasilan Tidak Kena Pajak PPh 21)

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

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BIODATA FORM
5. Previous Employers Riwayat Pekerjaan
Reason
Company Name Type Industry From - To (Awal - Akhir) Reporting to Job/Position Country - City For Leaving
Nama Perusahaan Tipe Industry (dd-mm-yy) Atasan Pekerjaan Negara- Kota Alasan keluar
*please choose one type industry
(pulp & paper, tissue, forestry,
1. PT. Arara Abadi 01-10-19 01-08-21 RiantoMarolop R&D Perawang Nyambung
others )
Kontrak

(pulp & paper, tissue, forestry,

2. PT. Arara Abadi 01-08-21 28-02-23 RiantoMarolop R&D Perawang Pengangkata
others ) n

(pulp & paper, tissue, forestry,

3. others )

(pulp & paper, tissue, forestry,

4. others )

Job Description at last position

(Tanggung jawan pekerjaan di posisi terakhir)

Bagian Labor bagian Persiapan sampel.

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

SMA PAKET C IPS 2019 2020

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

1. Mengemudi / Driver Nabila Mengemudi 2017 2017

2.

3.

8. Skills Keterampilan
Indonesia
Languages (Bahasa)
Ms. Word, Ms Excel
Computer / Program (Komputer / Program)

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. HIMNI 2020 Sekarang Anggota Indonesia

2.

3.

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10. Others Lain-lain
Yes R&D
1. Are you willing to be relocated No
Bersediakah anda untuk di relokasi? If yes, please state your prefered location (Jika ya, tuliskan lokasi yang dikehendaki)

2. Are you willing working on shifts? Yes No

Bersediakah Anda untuk bekerja dalam shifts?
Please state reason (alasan)
* For certain area and locations

3. Do you own any vehicle? Yes No

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

*5. Do you have family/ relatives at Company

Group? Yes No
If yes, please state detail : employee name, company and dept (Jika ya, sebutkan nama, karyawan
Apakah Anda mempunyai keluarga/ kerabat di Grup Perusahaan ini?
perusahaan, dan dept)

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

companies or hold directorship or other external/ part time Yes No
employment of other than your current company discussed
during recruitment process?
If yes, please state % of ownership or directorship or employment position and name of the company
Apakah anda memiliki / menjadi bagian dari kepemilikan perusahaan (Jika ya, sebutkan % kepemilikan atau jabatan directorship atau pekerjaan lainnya serta nama
atau memiliki jabatan directorship atau menjalani pekerjaan diluar/ perusahaan)
paruh waktu diluar pekerjaan anda saat ini?

*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 No
Company Group in the past?
Apakah Anda pernah mengikuti process di Grup Perusahaan ini? If yes, please state when and what company (Jika ya sebutkan kapan dan perusahaan)

8. How do you know about this Company?

Darimana Anda mengetahui mengenai Grup Perusahaan ini?
1st Dose - Please Select -
9. Have you completed your COVID 19 Vaccination? Yes No
Apakah anda sudah melakukan vaksinasi COVID 19? 2nd Dose - Please Select -
If yes, please state type and date of vaccination (1st and 2nd dose)
3rd Dose - Pfizer

10. Do you have any concern on COVID 19 Yes No If yes, please please choose one of the reason below :
Vaccination ?
Apakah anda memiliki kekhawatiran terhadap vaksinasi -Please Select-
Covid 19 ?

11. References Refer ensi

Name Company Phone Number Job/Position Relationship
Nama referensi Nama Perusahaan Nomor Telepon Pekerjaan Hubungan
FRD & R & D 082232609296 Kepala Seksi Pekerjaan
1. Bapak Arifin
FRD & R & D 082257446435 Koordinator Seksi Pekerjaan
2. Ibu Hobo

3.

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BIODATA FORM
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 Stefanus Yasama Gea

Tanggal 01 - 03 - 2023 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. Thank you.

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