PT PLN (PERSERO)
PANGGILAN TES FISIK (LULUS PSIKOTEST & LGD) REKRUTMEN TERBUKA MELALUI CAREER DAYS UGM XVI PT PLN (PERSERO) TINGKAT S2/S1/D3 TAHUN 2014 Bersama ini diumumkan daftar nama peserta yang lulus Psikotest & LGD dan berhak mengikuti tes fisik Rekrutmen Terbuka melalui Career Days UGM XVI. Ada pun tes fisik akan dilaksanakan pada :
HARI & TANGGAL
Tempat
BATCH
NOMOR URUT
WAKTU
1
1 – 50
07.00 WIB
Rabu,
2
51 - 100
09.00 WIB
29 Oktober 2014
3
101 – 150
11.00 WIB
4
151 - 205
13.00 WIB
: Laboratorium Klinik Prodia Jl. Bintaran Kulon 28 Yogyakarta Telp: 0274 375273/373271
1.
Peserta harap hadir 30 menit sebelum jadwal yang ditentukan untuk keperluan administrasi;
2.
Membawa KTP/kartu identitas yang berlaku dan kartu peserta;
3.
Peserta berpakaian sopan dan rapi, tidak mengenakan jeans, t-shirt atau sandal / sepatu sandal;
4.
Peserta agar membawa alat tulis;
5.
Peserta mencetak sendiri dan membawa formulir Anamnesa sebagaimana tercantum pada bagian akhir pengumuman ini dan dibawa saat pelaksanaan tes fisik. Meterai 6000 dan foto 3x4 berwarna (2 lembar), 1 lembar sudah ditempel pada saat menyerahkan formulir anamnesa;
6.
Setiap pengumuman ataupun Informasi mengenai rekrutmen PLN hanya melalui website PLN di www.pln.co.id atau akun twitter rekrutmen PLN di @rekrutmenpln atau ditempel di lokasi tes atau melalui website ECC UGM;
7.
Daftar peserta adalah sebagai berikut :
PT PLN (PERSERO) KANTOR PUSAT
DAFTAR PESERTA TES KESEHATAN FISIK REKRUTMEN TERBUKA MELALUI CAREER DAYS UGM XVI TINGKAT S2/S1/D3 TAHUN 2014 NO
NO TES
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47
1409/JOG/JF/S2/ELE/15363 1409/JOG/JF/S1/ELE/15368 1409/JOG/JF/S1/ELE/15369 1409/JOG/JF/S1/ELE/15371 1409/JOG/JF/S1/ELE/15373 1409/JOG/JF/S1/ELE/15374 1409/JOG/JF/S1/ELE/15376 1409/JOG/JF/S1/ELE/15377 1409/JOG/JF/S1/ELE/15378 1409/JOG/JF/S1/ELE/15379 1409/JOG/JF/S1/ELE/15382 1409/JOG/JF/S1/ELE/15383 1409/JOG/JF/S1/ELE/15385 1409/JOG/JF/S1/ELE/15386 1409/JOG/JF/S1/ELE/15391 1409/JOG/JF/S1/ELE/15392 1409/JOG/JF/S1/ELE/15393 1409/JOG/JF/S1/ELE/15394 1409/JOG/JF/S1/ELE/15396 1409/JOG/JF/S1/ELE/15397 1409/JOG/JF/S1/ELE/15398 1409/JOG/JF/S1/ELE/15399 1409/JOG/JF/S1/ELE/15401 1409/JOG/JF/S1/ELE/15403 1409/JOG/JF/S1/ELE/15406 1409/JOG/JF/S1/ELE/15407 1409/JOG/JF/S1/ELE/15408 1409/JOG/JF/S1/ELE/15413 1409/JOG/JF/S1/ELE/15416 1409/JOG/JF/S1/ELE/15419 1409/JOG/JF/S1/ELE/15422 1409/JOG/JF/S1/ELE/15423 1409/JOG/JF/S1/ELE/15425 1409/JOG/JF/S1/ELE/15427 1409/JOG/JF/S1/ELE/15428 1409/JOG/JF/S1/ELE/15429 1409/JOG/JF/S1/ELE/15431 1409/JOG/JF/S1/ELE/15434 1409/JOG/JF/S1/ELE/15435 1409/JOG/JF/S1/ELE/15436 1409/JOG/JF/S1/ELE/15437 1409/JOG/JF/S1/ELE/15440 1409/JOG/JF/S1/ELE/15442 1409/JOG/JF/S1/ELE/15445 1409/JOG/JF/S1/ELE/15446 1409/JOG/JF/S1/ELE/15447 1409/JOG/JF/S1/ELE/15448
JURUSAN
NAMA ARIEF BUDI MULYAWAN ADHITYA SUKMA WIJAYA ADI PRASETYO ADNAN ASHARI AHADI ANGGUN RAHARJO AHMAD HIDAYAT AKBAR AKHMAD AJI HARSA ALAM HARDIK DEWANTARA ALAN PONDANG M ALIEF MAKMURI HARTONO AMIR SOFYAN ANDHAR HANDHARI ANDI MUHAMMAD HAIKAL ANDRI RABIANSYAH APRI SETIAWAN ARIE PRASETIO ARIE SUKMA SETYA PUTRA ARIF BUDHI HARTO ARISKA MAISAR AULIA RAHMAN ALI BAYU HENDRIAWAN RAMADHAN BEN SHARON ARIO BERRI MARIHOT PANGGABEAN BRIAN CANDRA BRAHMANA BUDIMANSYAH CHANDRA FADLILAH CHRIS DOUGLAS NABABAN DHANI WAHYU UTAMA PUTRA DIMAS RIMANTIKTO DWI WAHYU CAHYO UTOMO EKO TRISWANTORO ERIK KRISPRASTAWA LAURENTIUS ERWIN ARIANTO FANDI ADITYA FEBRI ARIYANTO FEBRIAN WENAS NURLIAWAN FITONO GULO FRESKY AGUNG PRASETYO GATYA DHANAWAN WIJAYA GIDION GOLDWIN CAESAR SITUNGKIR HAMDAN NURONA HARLIAN SETIADI HERU PUJIYATMOKO HOTBE HASUGIAN I NUGROHO I PUTU AGUS SURYA PRAMANA Halaman 1 dari 4
S2 S1 S1 S1 S1 S1 S1 S1 S1 S1 S1 S1 S1 S1 S1 S1 S1 S1 S1 S1 S1 S1 S1 S1 S1 S1 S1 S1 S1 S1 S1 S1 S1 S1 S1 S1 S1 S1 S1 S1 S1 S1 S1 S1 S1 S1 S1
ELEKTRO ELEKTRO ELEKTRO ELEKTRO ELEKTRO ELEKTRO ELEKTRO ELEKTRO ELEKTRO ELEKTRO ELEKTRO ELEKTRO ELEKTRO ELEKTRO ELEKTRO ELEKTRO ELEKTRO ELEKTRO ELEKTRO ELEKTRO ELEKTRO ELEKTRO ELEKTRO ELEKTRO ELEKTRO ELEKTRO ELEKTRO ELEKTRO ELEKTRO ELEKTRO ELEKTRO ELEKTRO ELEKTRO ELEKTRO ELEKTRO ELEKTRO ELEKTRO ELEKTRO ELEKTRO ELEKTRO ELEKTRO ELEKTRO ELEKTRO ELEKTRO ELEKTRO ELEKTRO ELEKTRO
BATCH 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
NO
NO TES
48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101
1409/JOG/JF/S1/ELE/15451 1409/JOG/JF/S1/ELE/15453 1409/JOG/JF/S1/ELE/15454 1409/JOG/JF/S1/ELE/15457 1409/JOG/JF/S1/ELE/15461 1409/JOG/JF/S1/ELE/15463 1409/JOG/JF/S1/ELE/15464 1409/JOG/JF/S1/ELE/15466 1409/JOG/JF/S1/ELE/15469 1409/JOG/JF/S1/ELE/15471 1409/JOG/JF/S1/ELE/15472 1409/JOG/JF/S1/ELE/15474 1409/JOG/JF/S1/ELE/15475 1409/JOG/JF/S1/ELE/15478 1409/JOG/JF/S1/ELE/15482 1409/JOG/JF/S1/ELE/15484 1409/JOG/JF/S1/ELE/15489 1409/JOG/JF/S1/ELE/15490 1409/JOG/JF/S1/ELE/15492 1409/JOG/JF/S1/ELE/15498 1409/JOG/JF/S1/ELE/15500 1409/JOG/JF/S1/ELE/15501 1409/JOG/JF/S1/ELE/15506 1409/JOG/JF/S1/ELE/15508 1409/JOG/JF/S1/ELE/15511 1409/JOG/JF/S1/ELE/15513 1409/JOG/JF/S1/ELE/15514 1409/JOG/JF/S1/ELE/15515 1409/JOG/JF/S1/ELE/15516 1409/JOG/JF/S1/ELE/15518 1409/JOG/JF/S1/ELE/15519 1409/JOG/JF/S1/ELE/15521 1409/JOG/JF/S1/ELE/15523 1409/JOG/JF/S1/ELE/15524 1409/JOG/JF/S1/ELE/15526 1409/JOG/JF/S1/ELE/15528 1409/JOG/JF/S1/ELE/15530 1409/JOG/JF/S1/ELE/15531 1409/JOG/JF/S1/ELE/15533 1409/JOG/JF/S1/ELE/15535 1409/JOG/JF/S1/ALE/15538 1409/JOG/JF/S1/ALE/15539 1409/JOG/JF/S1/ALE/15541 1409/JOG/JF/S1/ALE/15542 1409/JOG/JF/S1/ALE/15543 1409/JOG/JF/S1/ALE/15545 1409/JOG/JF/S1/ALE/15551 1409/JOG/JF/S1/ALE/15555 1409/JOG/JF/S1/ALE/15563 1409/JOG/JF/S1/ALE/15565 1409/JOG/JF/S1/ALE/15567 1409/JOG/JF/S1/ALE/15571 1409/JOG/JF/S1/ALE/15574 1409/JOG/JF/S1/ALE/15579
JURUSAN
NAMA IMAM MUHTI ZEIN INDRIANTO IRFAN SETIAWAN ISWAHYUDI JULIAN MARULI TORANG MANURUNG LUKAS SANTORO LUQVI RIZKI SYAHPUTRA M. RIFKI APRIANSYAH MASRIANTO MIRSYAL MIRZA RAHIM MUHAMMAD AKBAR ALEXANDER DZULQORNAIN MUHAMMAD ANWAR MUSYADAD MUHAMMAD LUTHFIANIS MUKHLIS NUR AFIFI NOER AZIZ ISMAIL OPIK TAUFIQULLAH PANJI AGUS WICAKSONO PUPUT TRI WIJAYANTO RD M FAJAR RAMADHAN RENALDO MARSAL REZA HERYANTO SOLIKKIN RIO HERLY GUSHAN RISMANTO ARIF NUGROHO ROMY WADYOMUKTI RUDI ASRUDIN RUDY DHARMAWAN SATRIO AGUNG NUGROHO SAUT PAIAN SEPTIAN PURNAMA SETIYO NUGROHO SHOFYAN AJI UTAMA SUHUD NUR ILYAS SURYA ADJI PRATOMO TAUFIQ HIDAYAT TULUS WAHYU WIBOWO DWI ARDY PUTRA WAHYU PURNOMO WAYU DWIAFRIDHO A YOPPI ARDIAN NOVAL YUSUF FACHROJI ACHMAD ULUL AZMY ADAM SEPTIAN S ADITYA MUHTADI AGRA ARIE MUNANDA AGUNG RISTIANTO AHMAD ANUNG PROBO KUNCORO ALFIN IMADUL HAQ ANDRIAS MASIL BAGUS KETUT KARUNIA PRIMADANA BARADIANT IVANO LEOTMAN BAYU SETYAWAN BRYAN WISNU HERNADI DEFRIKO CHRISTIAN D. DIDIK HARI PURWANTO Halaman 2 dari 4
S1 S1 S1 S1 S1 S1 S1 S1 S1 S1 S1 S1 S1 S1 S1 S1 S1 S1 S1 S1 S1 S1 S1 S1 S1 S1 S1 S1 S1 S1 S1 S1 S1 S1 S1 S1 S1 S1 S1 S1 S1 S1 S1 S1 S1 S1 S1 S1 S1 S1 S1 S1 S1 S1
ELEKTRO ELEKTRO ELEKTRO ELEKTRO ELEKTRO ELEKTRO ELEKTRO ELEKTRO ELEKTRO ELEKTRO ELEKTRO ELEKTRO ELEKTRO ELEKTRO ELEKTRO ELEKTRO ELEKTRO ELEKTRO ELEKTRO ELEKTRO ELEKTRO ELEKTRO ELEKTRO ELEKTRO ELEKTRO ELEKTRO ELEKTRO ELEKTRO ELEKTRO ELEKTRO ELEKTRO ELEKTRO ELEKTRO ELEKTRO ELEKTRO ELEKTRO ELEKTRO ELEKTRO ELEKTRO ELEKTRO ELEKTRONIKA ELEKTRONIKA ELEKTRONIKA ELEKTRONIKA ELEKTRONIKA ELEKTRONIKA ELEKTRONIKA ELEKTRONIKA ELEKTRONIKA ELEKTRONIKA ELEKTRONIKA ELEKTRONIKA ELEKTRONIKA ELEKTRONIKA
BATCH 1 1 1 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 3
NO
NO TES
102 103 104 105 106 107 108 109 110 111 112 113 114 115 116 117 118 119 120 121 122 123 124 125 126 127 128 129 130 131 132 133 134 135 136 137 138 139 140 141 142 143 144 145 146 147 148 149 150 151 152 153 154 155
1409/JOG/JF/S1/ALE/15581 1409/JOG/JF/S1/ALE/15582 1409/JOG/JF/S1/ALE/15585 1409/JOG/JF/S1/ALE/15586 1409/JOG/JF/S1/ALE/15592 1409/JOG/JF/S1/ALE/15595 1409/JOG/JF/S1/ALE/15605 1409/JOG/JF/S1/ALE/15607 1409/JOG/JF/S1/ALE/15612 1409/JOG/JF/S1/ALE/15619 1409/JOG/JF/S1/ALE/15622 1409/JOG/JF/S1/ALE/15623 1409/JOG/JF/S1/ALE/15624 1409/JOG/JF/S1/ALE/15625 1409/JOG/JF/S1/ALE/15629 1409/JOG/JF/S1/ALE/15632 1409/JOG/JF/S1/ALE/15633 1409/JOG/JF/S1/ALE/15637 1409/JOG/JF/S1/ALE/15640 1409/JOG/JF/S1/ALE/15643 1409/JOG/JF/S1/ALE/15647 1409/JOG/JF/S1/ALE/15651 1409/JOG/JF/S1/ALE/15654 1409/JOG/JF/S1/ALE/15655 1409/JOG/JF/S1/ALE/15656 1409/JOG/JF/S1/ALE/15657 1409/JOG/JF/D3/ELE/15659 1409/JOG/JF/D3/ELE/15665 1409/JOG/JF/D3/ELE/15666 1409/JOG/JF/D3/ELE/15667 1409/JOG/JF/D3/ELE/15668 1409/JOG/JF/D3/ELE/15669 1409/JOG/JF/D3/ELE/15670 1409/JOG/JF/D3/ELE/15671 1409/JOG/JF/D3/ELE/15672 1409/JOG/JF/D3/ELE/15674 1409/JOG/JF/D3/ELE/15675 1409/JOG/JF/D3/ELE/15676 1409/JOG/JF/D3/ELE/15681 1409/JOG/JF/D3/ELE/15682 1409/JOG/JF/D3/ELE/15685 1409/JOG/JF/D3/ELE/15687 1409/JOG/JF/D3/ELE/15691 1409/JOG/JF/D3/ELE/15695 1409/JOG/JF/D3/ELE/15696 1409/JOG/JF/D3/ELE/15698 1409/JOG/JF/D3/ELE/15700 1409/JOG/JF/D3/ELE/15701 1409/JOG/JF/D3/ELE/15705 1409/JOG/JF/D3/ELE/15710 1409/JOG/JF/D3/ELE/15712 1409/JOG/JF/D3/ELE/15713 1409/JOG/JF/D3/ELE/15717 1409/JOG/JF/D3/ELE/15720
JURUSAN
NAMA EBTIAN APRIANTORO EGRIT NURCAHYO WIJATSONGKO FABIANUS MARINTIS DWIJAYATNO FADHIL RAMADHAN SANTOSO FLESENSIUS AGAM FRADISKA GUNTUR UTOMO PRASETYA JHON WESLY BANGUN KHOIRUL FANTRIS WIBOWO MOHAMMAD ADIL ELBANI MUHAMMAD SHOLEKAN N. A. MIFTAHUL HUDA NIDAUL MUIZ AUFA NUR IKHWAN SHOLIHIN NURWANTO YOGI SUTARI R BG PUGUH SETYANTO RACHMAT DIYANTO RANDI DWI WIBISONO RIHATMA PUNTA DEWA RUDI PRASETIO SATRANUSA SYAKBAN DWI KURNIAWAN WIHARSA PRAGITATAMA YUDHA AJI BRATA YULIAN SETIAJI YUSRI ACHDINUL HAKIM YUSUF AMIRUDDIN ACHMAD MUSHOFFA AJAR BUDI RAHARJO AJI UNGGUL PRASETIA ALEX SAMONA ANANG SETIAWAN ANDIK PRASETYOAJI SAPUTRO ANGGER EKA SAMEKTA ANGLING KAMESWARA ARDI WICAKSONO ARIF ROHMAN HAKIM ARIFAN SUKARNO PUTRA ARINDRA TRI PAMUNGKAS BOGGEY NOVENDRA SUSATMOKO DEVANDA ARIF PRATAMA DIRGA PRATAMA DWI HARTADI PRASETYO FAJAR AWAN SUMANTRI FEBRIAN DWI KURNIAWAN GANNY DIAS RAMATIKA HASAN MAHMUD HUSNUL YAQIN IRFAN GHOZALI MOTINGGO KANURI LUDFI KURNIAWAN M ALI HANAFIANSYAH M. FAUZI APRIANTO MUHAMMAD ABDUH MUHAMMAD ERWIN PRAYOGA Halaman 3 dari 4
S1 S1 S1 S1 S1 S1 S1 S1 S1 S1 S1 S1 S1 S1 S1 S1 S1 S1 S1 S1 S1 S1 S1 S1 S1 S1 D3 D3 D3 D3 D3 D3 D3 D3 D3 D3 D3 D3 D3 D3 D3 D3 D3 D3 D3 D3 D3 D3 D3 D3 D3 D3 D3 D3
ELEKTRONIKA ELEKTRONIKA ELEKTRONIKA ELEKTRONIKA ELEKTRONIKA ELEKTRONIKA ELEKTRONIKA ELEKTRONIKA ELEKTRONIKA ELEKTRONIKA ELEKTRONIKA ELEKTRONIKA ELEKTRONIKA ELEKTRONIKA ELEKTRONIKA ELEKTRONIKA ELEKTRONIKA ELEKTRONIKA ELEKTRONIKA ELEKTRONIKA ELEKTRONIKA ELEKTRONIKA ELEKTRONIKA ELEKTRONIKA ELEKTRONIKA ELEKTRONIKA ELEKTRO ELEKTRO ELEKTRO ELEKTRO ELEKTRO ELEKTRO ELEKTRO ELEKTRO ELEKTRO ELEKTRO ELEKTRO ELEKTRO ELEKTRO ELEKTRO ELEKTRO ELEKTRO ELEKTRO ELEKTRO ELEKTRO ELEKTRO ELEKTRO ELEKTRO ELEKTRO ELEKTRO ELEKTRO ELEKTRO ELEKTRO ELEKTRO
BATCH 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 4 4 4 4 4
NO
NO TES
156 157 158 159 160 161 162 163 164 165 166 167 168 169 170 171 172 173 174 175 176 177 178 179 180 181 182 183 184 185 186 187 188 189 190 191 192 193 194 195 196 197 198 199 200 201 202 203 204 205
1409/JOG/JF/D3/ELE/15726 1409/JOG/JF/D3/ELE/15729 1409/JOG/JF/D3/ELE/15731 1409/JOG/JF/D3/ELE/15733 1409/JOG/JF/D3/ELE/15734 1409/JOG/JF/D3/ELE/15737 1409/JOG/JF/D3/ELE/15741 1409/JOG/JF/D3/ELE/15743 1409/JOG/JF/D3/ELE/15744 1409/JOG/JF/D3/ELE/15745 1409/JOG/JF/D3/ELE/15746 1409/JOG/JF/D3/ELE/15747 1409/JOG/JF/D3/ALE/15750 1409/JOG/JF/D3/ALE/15752 1409/JOG/JF/D3/ALE/15755 1409/JOG/JF/D3/ALE/15757 1409/JOG/JF/D3/ALE/15758 1409/JOG/JF/D3/ALE/15759 1409/JOG/JF/D3/ALE/15761 1409/JOG/JF/D3/ALE/15765 1409/JOG/JF/D3/ALE/15770 1409/JOG/JF/D3/ALE/15773 1409/JOG/JF/D3/ALE/15775 1409/JOG/JF/D3/ALE/15781 1409/JOG/JF/D3/ALE/15783 1409/JOG/JF/D3/ALE/15784 1409/JOG/JF/D3/ALE/15797 1409/JOG/JF/D3/ALE/15799 1409/JOG/JF/D3/ALE/15800 1409/JOG/JF/D3/ALE/15802 1409/JOG/JF/D3/ALE/15803 1409/JOG/JF/D3/SIP/15809 1409/JOG/JF/D3/SIP/15812 1409/JOG/JF/D3/SIP/15813 1409/JOG/JF/D3/SIP/15816 1409/JOG/JF/D3/SIP/15818 1409/JOG/JF/D3/SIP/15819 1409/JOG/JF/D3/SIP/15820 1409/JOG/JF/D3/SIP/15826 1409/JOG/JF/D3/SIP/15830 1409/JOG/JF/D3/SIP/15836 1409/JOG/JF/D3/SIP/15849 1409/JOG/JF/D3/SIP/15851 1409/JOG/JF/D3/SIP/15852 1409/JOG/JF/D3/SIP/15854 1409/JOG/JF/D3/SIP/15855 1409/JOG/JF/D3/SIP/15861 1409/JOG/JF/D3/SIP/15863 1409/JOG/JF/D3/SIP/15864 1409/JOG/JF/D3/SIP/15865
JURUSAN
NAMA NOVIAN ESTIYO NUGROHO PUNGKAS SETIA WIBAWA RAFI AZIZ ADIBOWO REZA ADISETIA SAPUTRA REZA PRATAMA NUGRAHA SARIFULLAH KAMARUDIN TOYIB IMAM IBRAHIM VERGA WIDO PRATAMA WAHYU AJI KURNIAWAN WAHYU HARI SURYA WISMOYO HARIS MUNANDAR YUDHA SATRIA PERDHANA ADHE RIFKY IRFANSYAH ADITYA GRAHA AHMAD RAJIF MA'ARIF ANANDEA GANDHI ALLESKY ARBINO FEBRI WIDAWAN ARIE WIBOWO AWAL BAYU NIRWIWORO DANANG AJI PURWANTORO DWI JAYANTO ERLY SUGESTA FAISAL STYAWAN IDO INTOKO JUMHADI WIJAYANTO LANDUNG CAHYONO RIO AJI SAPUTRA RIYANTO RUDY SEPTIYAWAN SATRIA DIMAS SAPUTRA TAUFIQ HIDAYAT TRI SANTIKO WIDODO AFNI IBNA GHORIBUDDIN AGUS BUDI SETIAWAN AGUS CATUR PAMBUDI ANDIKA LAKSONO PUTERA ARDY RAHMA SAPUTRA ARIF KRISTANTO AULIYA FUAD ZAMZAMI DUWI HARIYANTO FERRY KURNIAWAN HADA MUSAKIM MUCHAMAD ALFIN RIZKA ALHADI MUHAMMAD RAJIF HUSAIN MUSTAGHFIRIN POBY RISTA YUHANDA PRADITYA WIRADIPATI NUR FATAH SAEFUL AMRI SEPTIAN BAGUS PERKASA SUTIKNO TAUFIQUR ROHMAN
D3 D3 D3 D3 D3 D3 D3 D3 D3 D3 D3 D3 D3 D3 D3 D3 D3 D3 D3 D3 D3 D3 D3 D3 D3 D3 D3 D3 D3 D3 D3 D3 D3 D3 D3 D3 D3 D3 D3 D3 D3 D3 D3 D3 D3 D3 D3 D3 D3 D3
ELEKTRO ELEKTRO ELEKTRO ELEKTRO ELEKTRO ELEKTRO ELEKTRO ELEKTRO ELEKTRO ELEKTRO ELEKTRO ELEKTRO ELEKTRONIKA ELEKTRONIKA ELEKTRONIKA ELEKTRONIKA ELEKTRONIKA ELEKTRONIKA ELEKTRONIKA ELEKTRONIKA ELEKTRONIKA ELEKTRONIKA ELEKTRONIKA ELEKTRONIKA ELEKTRONIKA ELEKTRONIKA ELEKTRONIKA ELEKTRONIKA ELEKTRONIKA ELEKTRONIKA ELEKTRONIKA SIPIL SIPIL SIPIL SIPIL SIPIL SIPIL SIPIL SIPIL SIPIL SIPIL SIPIL SIPIL SIPIL SIPIL SIPIL SIPIL SIPIL SIPIL SIPIL
JAKARTA, 24 OKTOBER 2014 TIM REKRUTMEN
Halaman 4 dari 4
BATCH 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4
PT PLN (PERSERO)
FORMULIR ANAMNESA CALON PEGAWAI FOTO 3X4 Lokasi Tes : ___________________ Tanggal : ___________________ Nomor Lab. : ___________________ (Kolom ini diisi petugas) IDENTITAS PESERTA 1. 2. 3. 4. 5. 6.
Nama No. Tes Jenis Kelamin Tempat/Tgl Lahir Status Alamat
: : : Laki-Laki / Perempuan *) : : Kawin / Duda / Janda / Belum Menikah*) : ________________________________________________________________ ________________________________________________________________ RIWAYAT PEMERIKSAAN KESEHATAN
Apakah Anda pernah mengikuti tes kesehatan sebelumnya : Ya / Tidak *) Jika jawaban Anda ya, maka : 1. Lokasi : ______________ 2. Tanggal : ____ Bulan ____ Tahun ____ 3. Keperluan: ___________ 4. Hasil : Lulus / Tidak *) RIWAYAT PENYAKIT 1.
Penyakit yang pernah diderita (beri tanda √ pada pilihan Anda) : Berilah tanda (√) apabila kondisi-kondisi tersebut pernah Anda alami atau Anda alami selama 3 bulan terakhir
Penyakit/Kondisi
Ya
Tidak
Tdk Tahu
Penyakit/Kondisi
Ya
Tidak
Tdk Tahu
Penyakit/Kondisi
Saluran Nafas
Saluran Cerna
Sendi & Tulang
Sinusitis
Typhoid
Radang Sendi/Rematik
Bronchitis
Muntah Darah
Penyakit Lain
Batuk Darah
Sulit BAB
Alergi Makanan
TBC
Sakit Lambung/Maag
Makanan : …………………..
Radang Paru
Penyakit Kuning
Alergi Obat
Asma
Penyakit Kantung Empedu
Obat :
Sesak Nafas
Buang Air Besar Berdarah
Tetanus
Ginjal & Saluran Kemih
Sering Diare
Pingsan
Sulit Buang Air Kecil
Gangguan Menelan
Pelupa
Radang Saluran Kemih
Kulit & Kelamin
Gangguan Pendengaran
Ya
Tidak
Tdk Tahu
1
PT PLN (PERSERO)
Penyakit Ginjal
Cacar Air
Sakit Pinggang
Kencing Batu
Jamur Kulit
Tumor Ganas/Kangker
Jaringan Syaraf
Penyakit Kelamin
Penyakit Jiwa
Radang Selaput Otak/meningitis
Jantung
TBC Kulit
Gegar Otak
Serangan Jantung
TBC Tulang & Lainnya
Polio
Nyeri dada
Campak
Ayan/Epilepsi
Rasa Berdebar
Malaria
Stroke/Lumpuh
Tekanan Darah Tinggi
Diabetes
Sakit Kepala
Pembuluh Darah
Gangguan Tidur
Kelenjar
Ambeien/Wasir
Penyakit Gondok/Thyroid
Varises
2. 3.
4.
5.
6.
Pengobatan jangka waktu yang lama: pernah / tidak pernah *) Penyakit apa: _____________ Kapan: ____________ Jenis obat : ___________________ Riwayat Merokok : a. Jumlah : ____ batang / hari b. Mulai Merokok : _______________ Riwayat konsumsi alkohol : a. Jumlah : ________ gelas / sloki / botol / hari b. Mulai konsumsi : _____________________________ c. Jenis : _____________________________ Kejadian Lain : a. Kecelakaan : pernah / tidak Kapan ___________ Jenis Kecelakaan _________ b. Operasi : pernah / tidak Kapan ___________ Jenis Operasi ____________ c. Dirawat di Rumah Sakit : pernah / tidak Kapan ___________ Jenis Operasi ____________ Penyakit dalam keluarga : a. Ayah b. Ibu c. Saudara Kandung d. Penyakit yang pernah diderita : (sesuaikan dengan nomor 1) ________________ oleh ____________(ayah /ibu /saudara kandung) KEBIASAAN KHUSUS
1. 2. 3.
Pola makan / diet khusus : _______________________________ Olah raga : Jenis ___________ Rutin / Tidak Rutin*) Frekuensi / minggu*) ____________ Lain-Lain : ____________________________________________________________________
2
PT PLN (PERSERO) Demikian keterangan di atas Saya berikan dengan sesungguhnya dan saya bersedia dinyatakan gugur dalam seleksi PLN jika ternyata Saya memberikan keterangan yang tidak benar.
__________ , _________ 2014 Mengetahui, Dokter Pemeriksa
Peserta Seleksi
Materai Rp 6000
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