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BUMI ARASY HRD & Management Consultant FORMULIR PENDAFTARAN Nama Lengkap : ....................................................................................................................................... (Gelar Kesarjanaan) Tempat Tanggal Lahir : ....................................................................................................................................... Jenis Kelamin : P = Pria Pendidikan Terakhir : 1 = SMA Alamat Rumah : ....................................................................................................................................... Kota/Provinsi : ……………………………………………………………………….. Kode Pos: ......................................... Handphone : ....................................................................................................................................... Telepon Rumah : ....................................................................................................................................... Email Pribadi : ....................................................................................................................................... W = Wanita 2 = D3 3 = S1 4 = S2 5 = S3 INFORMASI PERUSAHAAN Nama Perusahaan : ....................................................................................................................................... Alamat : ....................................................................................................................................... Kota/Provinsi : ……………………………………………………………………….. Kode Pos: ......................................... Telepon : …………………………………………………….. Fax. ...................................................................... Email Kantor : ....................................................................................................................................... Kategori Jabatan : 1 = Puncak Bidang Pekerjaan : 1 = Pemasaran Status Perusahaan : SN = Swasta Nasional Jenis Usaha : 1 = Industri 2 = Madya 2 = Keuangan 3 = Muda 3 = Produksi SA = Swasta Asing 2 = Perdagangan 4 = Supervisor 4 = SDM JV = Join Venture 3 = Konstruksi 4 = Jasa 5 = Staff 5 = Umum BU = BUMN 5 = Sosial 6 = Pertambangan Produk Bidang : ....................................................................................................................................... Paket Pelatihan yang diambil : 1 = Supervisory Management Development Program 2 = Middle Management Development Program 3 = Advance Management Development Program 4 = Executive Management Development Program 5 = Leadership Character Building 6 = Business Coach Seminar 7 = Leadership & Business Owner Academy 8 = Business Coach Bumi Arasy HRD & Management Consultant Jl. Manggis Raya No 2D – 2E Cinere, Depok 16514 Telp. 021 – 753 7777 Fax. 021 – 753 2909 www.bumiarasy.com Email: [email protected]