APPLICATION FORM

OFFICIAL
CIMSA
UMS
2017-2018
 CURRICULUM VITAE
PERSONAL IDENTIFICATION
1. Name (first/middle/last) :
2. Nickname :
3. Sex :
4. Place, Date of Birth :
5. Age :
6. Blood :
7. Mobile :
8. Religion :
9. Language :
10. E-mail :
11. Address :

MEMBER IDENTIFICATION
1. ID card number :
2. Member CIMSA since :
3. Member of SCO :
4. National Meeting Attandance :

EDUCATION
1. Elementary School :
2. Junior High School :
3. Senior High School :
4. University :
5. Organizational experience :
ACHIEVEMENT

(Sukoharjo , 27 June 2017)

Sincerely,

NAMA LENGKAP
 TECHNICAL DATA CARD

1. Name (first/middle/last) :

2. Current Position in Local:

FOTO
3. Candidate for :

4. Address :

5. Phone :

6. Cell Phone :

7. Fax :

8. Email :

9. Personal Homepage :

(Sukoharjo , 27 June 2017)

Sincerely,

NAMA LENGKAP
 MOTIVATION LETTER
Diisi minimal 500 kata

(Sukoharjo , 27 June 2017)

Sincerely,

NAMA LENGKAP