formulir hmm

HIMPUNAN MAHASISWA MESIN (HMM)FAKULTAS TEKNIK UNIVERSITAS SRIWIJAYAKampus Universitas Sriwijaya Zona E, Fakultas Teknik, Jurusan Teknik Mesin

Jalan Raya Palembang-Prabumulih Km.32. Inderalaya-Ogan Ilir

FORMULIR BIODATA HIMPUNAN MAHASISWA MESIN (HMM)OPEN RECRUITMENT 2008 – 2009

Nama Lengkap : ...............................................................................................................................

Nama Panggilan : ................................................................................................................................

NIM : ................................................................................................................................

Tempat/tgl lahir : ................................................................................................................................

Jenis Kelamin : ...............................................................................................................................

Agama : ................................................................................................................................

Alamat Sekarang : ................................................................................................................................

Alamat Asal : ................................................................................................................................

NO. Telp/Hp : ................................................................................................................................

Hobby : ................................................................................................................................

Motto Hidup : ................................................................................................................................

Saran & Kritik HMM :

Saran : ……………………………………………………………………………………………………………………………………………………………………………………………………………………….....Kritik :............................................................................................................................................................................................................................................................................................................................................

Riwayat Pendidikan FormalTingkat Nama Kota/Provinsi Tahun

LulusSD

SMP/MTSSMA/SMK/MAN

Riwayat OrganisasiNo. Tingkat Nama Organisasi Jabatan Tahun

Ikrar Pengurus :Dengan ini saya menyatakan bahwa data yang telah diisi tanpa rekayasa dan saya berjanji untuk mengabdi serta mengemban tugas di Himpunan Mahasiswa Mesin (HMM) pada periode 2008 – 2009.

Inderalaya, Desember 2008

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NIIM : ..............................