FR-PSB-LAA-XXII.001.

01

FORMULIR PENDAFTARAN
PRAKTIK KERJA INDUSTRI (PRAKERIN)

Program Studi :  TRL  SVM  PM

Nama Mahasiswa : ………………………………………………………………………….

NIM : ………………………………………………………………………….

No. HP : ………………………………………………………………………….

SKS yang Sudah

: ………………... SKS IPK ………............…………….
Ditempuh

Nama Perusahaan : ………………………………………………………………………….

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Alamat Perusahaan : ………………………………………………………………………….

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Periode Prakerin : ………………………………s/d………………………………………

Berau, .......................................
.

Menyetujui,
Pembimbing Prakerin Mahasiswa

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NIDN. ............................... NIM. ...................................

Mengetahui,
Kepala Program Studi

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NIDN. ............................

Catatan: lampirkan 1 halaman berisi profil perusahaan yang ingin dituju

 FR-PSB-LAA-XXII.001.01

LAMPIRAN
PROFIL PT. XYZ

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