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 BATCH NOMOR URUT WAKTU
Rabu,
29 Oktober 2014
1 1 – 50 07.00 WIB 2 51 - 100 09.00 WIB 3 101 – 150 11.00 WIB 4 151 - 205 13.00 WIBTempat :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;
KANTOR PUSAT
NO
NO TES
NAMA
BATCH
1 1409/JOG/JF/S2/ELE/15363 ARIEF BUDI MULYAWAN S2 ELEKTRO 1
2 1409/JOG/JF/S1/ELE/15368 ADHITYA SUKMA WIJAYA S1 ELEKTRO 1
3 1409/JOG/JF/S1/ELE/15369 ADI PRASETYO S1 ELEKTRO 1
4 1409/JOG/JF/S1/ELE/15371 ADNAN ASHARI S1 ELEKTRO 1
5 1409/JOG/JF/S1/ELE/15373 AHADI ANGGUN RAHARJO S1 ELEKTRO 1
6 1409/JOG/JF/S1/ELE/15374 AHMAD HIDAYAT AKBAR S1 ELEKTRO 1
7 1409/JOG/JF/S1/ELE/15376 AKHMAD AJI HARSA S1 ELEKTRO 1
8 1409/JOG/JF/S1/ELE/15377 ALAM HARDIK DEWANTARA S1 ELEKTRO 1
9 1409/JOG/JF/S1/ELE/15378 ALAN PONDANG M S1 ELEKTRO 1
10 1409/JOG/JF/S1/ELE/15379 ALIEF MAKMURI HARTONO S1 ELEKTRO 1
11 1409/JOG/JF/S1/ELE/15382 AMIR SOFYAN S1 ELEKTRO 1
12 1409/JOG/JF/S1/ELE/15383 ANDHAR HANDHARI S1 ELEKTRO 1
13 1409/JOG/JF/S1/ELE/15385 ANDI MUHAMMAD HAIKAL S1 ELEKTRO 1
14 1409/JOG/JF/S1/ELE/15386 ANDRI RABIANSYAH S1 ELEKTRO 1
15 1409/JOG/JF/S1/ELE/15391 APRI SETIAWAN S1 ELEKTRO 1
16 1409/JOG/JF/S1/ELE/15392 ARIE PRASETIO S1 ELEKTRO 1
17 1409/JOG/JF/S1/ELE/15393 ARIE SUKMA SETYA PUTRA S1 ELEKTRO 1
18 1409/JOG/JF/S1/ELE/15394 ARIF BUDHI HARTO S1 ELEKTRO 1
19 1409/JOG/JF/S1/ELE/15396 ARISKA MAISAR S1 ELEKTRO 1
20 1409/JOG/JF/S1/ELE/15397 AULIA RAHMAN ALI S1 ELEKTRO 1
21 1409/JOG/JF/S1/ELE/15398 BAYU HENDRIAWAN RAMADHAN S1 ELEKTRO 1
22 1409/JOG/JF/S1/ELE/15399 BEN SHARON ARIO S1 ELEKTRO 1
23 1409/JOG/JF/S1/ELE/15401 BERRI MARIHOT PANGGABEAN S1 ELEKTRO 1
24 1409/JOG/JF/S1/ELE/15403 BRIAN CANDRA BRAHMANA S1 ELEKTRO 1
25 1409/JOG/JF/S1/ELE/15406 BUDIMANSYAH S1 ELEKTRO 1
26 1409/JOG/JF/S1/ELE/15407 CHANDRA FADLILAH S1 ELEKTRO 1
27 1409/JOG/JF/S1/ELE/15408 CHRIS DOUGLAS NABABAN S1 ELEKTRO 1
28 1409/JOG/JF/S1/ELE/15413 DHANI WAHYU UTAMA PUTRA S1 ELEKTRO 1
29 1409/JOG/JF/S1/ELE/15416 DIMAS RIMANTIKTO S1 ELEKTRO 1
30 1409/JOG/JF/S1/ELE/15419 DWI WAHYU CAHYO UTOMO S1 ELEKTRO 1
31 1409/JOG/JF/S1/ELE/15422 EKO TRISWANTORO S1 ELEKTRO 1
32 1409/JOG/JF/S1/ELE/15423 ERIK KRISPRASTAWA LAURENTIUS S1 ELEKTRO 1
33 1409/JOG/JF/S1/ELE/15425 ERWIN ARIANTO S1 ELEKTRO 1
34 1409/JOG/JF/S1/ELE/15427 FANDI ADITYA S1 ELEKTRO 1
35 1409/JOG/JF/S1/ELE/15428 FEBRI ARIYANTO S1 ELEKTRO 1
36 1409/JOG/JF/S1/ELE/15429 FEBRIAN WENAS NURLIAWAN S1 ELEKTRO 1
37 1409/JOG/JF/S1/ELE/15431 FITONO GULO S1 ELEKTRO 1
38 1409/JOG/JF/S1/ELE/15434 FRESKY AGUNG PRASETYO S1 ELEKTRO 1
39 1409/JOG/JF/S1/ELE/15435 GATYA DHANAWAN WIJAYA S1 ELEKTRO 1
40 1409/JOG/JF/S1/ELE/15436 GIDION S1 ELEKTRO 1
41 1409/JOG/JF/S1/ELE/15437 GOLDWIN CAESAR SITUNGKIR S1 ELEKTRO 1
42 1409/JOG/JF/S1/ELE/15440 HAMDAN NURONA S1 ELEKTRO 1
43 1409/JOG/JF/S1/ELE/15442 HARLIAN SETIADI S1 ELEKTRO 1
44 1409/JOG/JF/S1/ELE/15445 HERU PUJIYATMOKO S1 ELEKTRO 1
45 1409/JOG/JF/S1/ELE/15446 HOTBE HASUGIAN S1 ELEKTRO 1
46 1409/JOG/JF/S1/ELE/15447 I NUGROHO S1 ELEKTRO 1
47 1409/JOG/JF/S1/ELE/15448 I PUTU AGUS SURYA PRAMANA S1 ELEKTRO 1
JURUSAN
TINGKAT S2/S1/D3 TAHUN 2014
REKRUTMEN TERBUKA MELALUI CAREER DAYS UGM XVI
DAFTAR PESERTA TES KESEHATAN FISIK
NO
NO TES
NAMA
JURUSAN
BATCH
48 1409/JOG/JF/S1/ELE/15451 IMAM MUHTI ZEIN S1 ELEKTRO 1
49 1409/JOG/JF/S1/ELE/15453 INDRIANTO S1 ELEKTRO 1
50 1409/JOG/JF/S1/ELE/15454 IRFAN SETIAWAN S1 ELEKTRO 1
51 1409/JOG/JF/S1/ELE/15457 ISWAHYUDI S1 ELEKTRO 2
52 1409/JOG/JF/S1/ELE/15461 JULIAN MARULI TORANG MANURUNG S1 ELEKTRO 2
53 1409/JOG/JF/S1/ELE/15463 LUKAS SANTORO S1 ELEKTRO 2
54 1409/JOG/JF/S1/ELE/15464 LUQVI RIZKI SYAHPUTRA S1 ELEKTRO 2
55 1409/JOG/JF/S1/ELE/15466 M. RIFKI APRIANSYAH S1 ELEKTRO 2
56 1409/JOG/JF/S1/ELE/15469 MASRIANTO S1 ELEKTRO 2
57 1409/JOG/JF/S1/ELE/15471 MIRSYAL S1 ELEKTRO 2
58 1409/JOG/JF/S1/ELE/15472 MIRZA RAHIM S1 ELEKTRO 2
59 1409/JOG/JF/S1/ELE/15474 MUHAMMAD AKBAR ALEXANDER DZULQORNAIN S1 ELEKTRO 2
60 1409/JOG/JF/S1/ELE/15475 MUHAMMAD ANWAR MUSYADAD S1 ELEKTRO 2
61 1409/JOG/JF/S1/ELE/15478 MUHAMMAD LUTHFIANIS S1 ELEKTRO 2
62 1409/JOG/JF/S1/ELE/15482 MUKHLIS NUR AFIFI S1 ELEKTRO 2
63 1409/JOG/JF/S1/ELE/15484 NOER AZIZ ISMAIL S1 ELEKTRO 2
64 1409/JOG/JF/S1/ELE/15489 OPIK TAUFIQULLAH S1 ELEKTRO 2
65 1409/JOG/JF/S1/ELE/15490 PANJI AGUS WICAKSONO S1 ELEKTRO 2
66 1409/JOG/JF/S1/ELE/15492 PUPUT TRI WIJAYANTO S1 ELEKTRO 2
67 1409/JOG/JF/S1/ELE/15498 RD M FAJAR RAMADHAN S1 ELEKTRO 2
68 1409/JOG/JF/S1/ELE/15500 RENALDO MARSAL S1 ELEKTRO 2
69 1409/JOG/JF/S1/ELE/15501 REZA HERYANTO SOLIKKIN S1 ELEKTRO 2
70 1409/JOG/JF/S1/ELE/15506 RIO HERLY GUSHAN S1 ELEKTRO 2
71 1409/JOG/JF/S1/ELE/15508 RISMANTO ARIF NUGROHO S1 ELEKTRO 2
72 1409/JOG/JF/S1/ELE/15511 ROMY WADYOMUKTI S1 ELEKTRO 2
73 1409/JOG/JF/S1/ELE/15513 RUDI ASRUDIN S1 ELEKTRO 2
74 1409/JOG/JF/S1/ELE/15514 RUDY DHARMAWAN S1 ELEKTRO 2
75 1409/JOG/JF/S1/ELE/15515 SATRIO AGUNG NUGROHO S1 ELEKTRO 2
76 1409/JOG/JF/S1/ELE/15516 SAUT PAIAN S1 ELEKTRO 2
77 1409/JOG/JF/S1/ELE/15518 SEPTIAN PURNAMA S1 ELEKTRO 2
78 1409/JOG/JF/S1/ELE/15519 SETIYO NUGROHO S1 ELEKTRO 2
79 1409/JOG/JF/S1/ELE/15521 SHOFYAN AJI UTAMA S1 ELEKTRO 2
80 1409/JOG/JF/S1/ELE/15523 SUHUD NUR ILYAS S1 ELEKTRO 2
81 1409/JOG/JF/S1/ELE/15524 SURYA ADJI PRATOMO S1 ELEKTRO 2
82 1409/JOG/JF/S1/ELE/15526 TAUFIQ HIDAYAT S1 ELEKTRO 2
83 1409/JOG/JF/S1/ELE/15528 TULUS WAHYU WIBOWO DWI ARDY PUTRA S1 ELEKTRO 2
84 1409/JOG/JF/S1/ELE/15530 WAHYU PURNOMO S1 ELEKTRO 2
85 1409/JOG/JF/S1/ELE/15531 WAYU DWIAFRIDHO A S1 ELEKTRO 2
86 1409/JOG/JF/S1/ELE/15533 YOPPI ARDIAN NOVAL S1 ELEKTRO 2
87 1409/JOG/JF/S1/ELE/15535 YUSUF FACHROJI S1 ELEKTRO 2
88 1409/JOG/JF/S1/ALE/15538 ACHMAD ULUL AZMY S1 ELEKTRONIKA 2
89 1409/JOG/JF/S1/ALE/15539 ADAM SEPTIAN S S1 ELEKTRONIKA 2
90 1409/JOG/JF/S1/ALE/15541 ADITYA MUHTADI S1 ELEKTRONIKA 2
91 1409/JOG/JF/S1/ALE/15542 AGRA ARIE MUNANDA S1 ELEKTRONIKA 2
92 1409/JOG/JF/S1/ALE/15543 AGUNG RISTIANTO S1 ELEKTRONIKA 2
93 1409/JOG/JF/S1/ALE/15545 AHMAD ANUNG PROBO KUNCORO S1 ELEKTRONIKA 2
94 1409/JOG/JF/S1/ALE/15551 ALFIN IMADUL HAQ S1 ELEKTRONIKA 2
95 1409/JOG/JF/S1/ALE/15555 ANDRIAS MASIL S1 ELEKTRONIKA 2
96 1409/JOG/JF/S1/ALE/15563 BAGUS KETUT KARUNIA PRIMADANA S1 ELEKTRONIKA 2
97 1409/JOG/JF/S1/ALE/15565 BARADIANT IVANO LEOTMAN S1 ELEKTRONIKA 2
98 1409/JOG/JF/S1/ALE/15567 BAYU SETYAWAN S1 ELEKTRONIKA 2
99 1409/JOG/JF/S1/ALE/15571 BRYAN WISNU HERNADI S1 ELEKTRONIKA 2
100 1409/JOG/JF/S1/ALE/15574 DEFRIKO CHRISTIAN D. S1 ELEKTRONIKA 2
102 1409/JOG/JF/S1/ALE/15581 EBTIAN APRIANTORO S1 ELEKTRONIKA 3
103 1409/JOG/JF/S1/ALE/15582 EGRIT NURCAHYO WIJATSONGKO S1 ELEKTRONIKA 3
104 1409/JOG/JF/S1/ALE/15585 FABIANUS MARINTIS DWIJAYATNO S1 ELEKTRONIKA 3
105 1409/JOG/JF/S1/ALE/15586 FADHIL RAMADHAN SANTOSO S1 ELEKTRONIKA 3
106 1409/JOG/JF/S1/ALE/15592 FLESENSIUS AGAM FRADISKA S1 ELEKTRONIKA 3
107 1409/JOG/JF/S1/ALE/15595 GUNTUR UTOMO PRASETYA S1 ELEKTRONIKA 3
108 1409/JOG/JF/S1/ALE/15605 JHON WESLY BANGUN S1 ELEKTRONIKA 3
109 1409/JOG/JF/S1/ALE/15607 KHOIRUL FANTRIS WIBOWO S1 ELEKTRONIKA 3
110 1409/JOG/JF/S1/ALE/15612 MOHAMMAD ADIL ELBANI S1 ELEKTRONIKA 3
111 1409/JOG/JF/S1/ALE/15619 MUHAMMAD SHOLEKAN S1 ELEKTRONIKA 3
112 1409/JOG/JF/S1/ALE/15622 N. A. MIFTAHUL HUDA S1 ELEKTRONIKA 3
113 1409/JOG/JF/S1/ALE/15623 NIDAUL MUIZ AUFA S1 ELEKTRONIKA 3
114 1409/JOG/JF/S1/ALE/15624 NUR IKHWAN SHOLIHIN S1 ELEKTRONIKA 3
115 1409/JOG/JF/S1/ALE/15625 NURWANTO YOGI SUTARI S1 ELEKTRONIKA 3
116 1409/JOG/JF/S1/ALE/15629 R BG PUGUH SETYANTO S1 ELEKTRONIKA 3
117 1409/JOG/JF/S1/ALE/15632 RACHMAT DIYANTO S1 ELEKTRONIKA 3
118 1409/JOG/JF/S1/ALE/15633 RANDI DWI WIBISONO S1 ELEKTRONIKA 3
119 1409/JOG/JF/S1/ALE/15637 RIHATMA PUNTA DEWA S1 ELEKTRONIKA 3
120 1409/JOG/JF/S1/ALE/15640 RUDI PRASETIO S1 ELEKTRONIKA 3
121 1409/JOG/JF/S1/ALE/15643 SATRANUSA S1 ELEKTRONIKA 3
122 1409/JOG/JF/S1/ALE/15647 SYAKBAN DWI KURNIAWAN S1 ELEKTRONIKA 3
123 1409/JOG/JF/S1/ALE/15651 WIHARSA PRAGITATAMA S1 ELEKTRONIKA 3
124 1409/JOG/JF/S1/ALE/15654 YUDHA AJI BRATA S1 ELEKTRONIKA 3
125 1409/JOG/JF/S1/ALE/15655 YULIAN SETIAJI S1 ELEKTRONIKA 3
126 1409/JOG/JF/S1/ALE/15656 YUSRI ACHDINUL HAKIM S1 ELEKTRONIKA 3
127 1409/JOG/JF/S1/ALE/15657 YUSUF AMIRUDDIN S1 ELEKTRONIKA 3
128 1409/JOG/JF/D3/ELE/15659 ACHMAD MUSHOFFA D3 ELEKTRO 3
129 1409/JOG/JF/D3/ELE/15665 AJAR BUDI RAHARJO D3 ELEKTRO 3
130 1409/JOG/JF/D3/ELE/15666 AJI UNGGUL PRASETIA D3 ELEKTRO 3
131 1409/JOG/JF/D3/ELE/15667 ALEX SAMONA D3 ELEKTRO 3
132 1409/JOG/JF/D3/ELE/15668 ANANG SETIAWAN D3 ELEKTRO 3
133 1409/JOG/JF/D3/ELE/15669 ANDIK PRASETYOAJI SAPUTRO D3 ELEKTRO 3
134 1409/JOG/JF/D3/ELE/15670 ANGGER EKA SAMEKTA D3 ELEKTRO 3
135 1409/JOG/JF/D3/ELE/15671 ANGLING KAMESWARA D3 ELEKTRO 3
136 1409/JOG/JF/D3/ELE/15672 ARDI WICAKSONO D3 ELEKTRO 3
137 1409/JOG/JF/D3/ELE/15674 ARIF ROHMAN HAKIM D3 ELEKTRO 3
138 1409/JOG/JF/D3/ELE/15675 ARIFAN SUKARNO PUTRA D3 ELEKTRO 3
139 1409/JOG/JF/D3/ELE/15676 ARINDRA TRI PAMUNGKAS D3 ELEKTRO 3
140 1409/JOG/JF/D3/ELE/15681 BOGGEY NOVENDRA SUSATMOKO D3 ELEKTRO 3
141 1409/JOG/JF/D3/ELE/15682 DEVANDA ARIF PRATAMA D3 ELEKTRO 3
142 1409/JOG/JF/D3/ELE/15685 DIRGA PRATAMA D3 ELEKTRO 3
143 1409/JOG/JF/D3/ELE/15687 DWI HARTADI PRASETYO D3 ELEKTRO 3
144 1409/JOG/JF/D3/ELE/15691 FAJAR AWAN SUMANTRI D3 ELEKTRO 3
145 1409/JOG/JF/D3/ELE/15695 FEBRIAN DWI KURNIAWAN D3 ELEKTRO 3
146 1409/JOG/JF/D3/ELE/15696 GANNY DIAS RAMATIKA D3 ELEKTRO 3
147 1409/JOG/JF/D3/ELE/15698 HASAN MAHMUD D3 ELEKTRO 3
148 1409/JOG/JF/D3/ELE/15700 HUSNUL YAQIN D3 ELEKTRO 3
149 1409/JOG/JF/D3/ELE/15701 IRFAN GHOZALI MOTINGGO D3 ELEKTRO 3
150 1409/JOG/JF/D3/ELE/15705 KANURI D3 ELEKTRO 3
151 1409/JOG/JF/D3/ELE/15710 LUDFI KURNIAWAN D3 ELEKTRO 4
152 1409/JOG/JF/D3/ELE/15712 M ALI HANAFIANSYAH D3 ELEKTRO 4
153 1409/JOG/JF/D3/ELE/15713 M. FAUZI APRIANTO D3 ELEKTRO 4
154 1409/JOG/JF/D3/ELE/15717 MUHAMMAD ABDUH D3 ELEKTRO 4
NO
NO TES
NAMA
JURUSAN
BATCH
156 1409/JOG/JF/D3/ELE/15726 NOVIAN ESTIYO NUGROHO D3 ELEKTRO 4
157 1409/JOG/JF/D3/ELE/15729 PUNGKAS SETIA WIBAWA D3 ELEKTRO 4
158 1409/JOG/JF/D3/ELE/15731 RAFI AZIZ ADIBOWO D3 ELEKTRO 4
159 1409/JOG/JF/D3/ELE/15733 REZA ADISETIA SAPUTRA D3 ELEKTRO 4
160 1409/JOG/JF/D3/ELE/15734 REZA PRATAMA NUGRAHA D3 ELEKTRO 4
161 1409/JOG/JF/D3/ELE/15737 SARIFULLAH KAMARUDIN D3 ELEKTRO 4
162 1409/JOG/JF/D3/ELE/15741 TOYIB IMAM IBRAHIM D3 ELEKTRO 4
163 1409/JOG/JF/D3/ELE/15743 VERGA WIDO PRATAMA D3 ELEKTRO 4
164 1409/JOG/JF/D3/ELE/15744 WAHYU AJI KURNIAWAN D3 ELEKTRO 4
165 1409/JOG/JF/D3/ELE/15745 WAHYU HARI SURYA D3 ELEKTRO 4
166 1409/JOG/JF/D3/ELE/15746 WISMOYO HARIS MUNANDAR D3 ELEKTRO 4
167 1409/JOG/JF/D3/ELE/15747 YUDHA SATRIA PERDHANA D3 ELEKTRO 4
168 1409/JOG/JF/D3/ALE/15750 ADHE RIFKY IRFANSYAH D3 ELEKTRONIKA 4
169 1409/JOG/JF/D3/ALE/15752 ADITYA GRAHA D3 ELEKTRONIKA 4
170 1409/JOG/JF/D3/ALE/15755 AHMAD RAJIF MA'ARIF D3 ELEKTRONIKA 4
171 1409/JOG/JF/D3/ALE/15757 ANANDEA GANDHI ALLESKY D3 ELEKTRONIKA 4
172 1409/JOG/JF/D3/ALE/15758 ARBINO FEBRI WIDAWAN D3 ELEKTRONIKA 4
173 1409/JOG/JF/D3/ALE/15759 ARIE WIBOWO D3 ELEKTRONIKA 4
174 1409/JOG/JF/D3/ALE/15761 AWAL BAYU NIRWIWORO D3 ELEKTRONIKA 4
175 1409/JOG/JF/D3/ALE/15765 DANANG AJI PURWANTORO D3 ELEKTRONIKA 4
176 1409/JOG/JF/D3/ALE/15770 DWI JAYANTO D3 ELEKTRONIKA 4
177 1409/JOG/JF/D3/ALE/15773 ERLY SUGESTA D3 ELEKTRONIKA 4
178 1409/JOG/JF/D3/ALE/15775 FAISAL STYAWAN D3 ELEKTRONIKA 4
179 1409/JOG/JF/D3/ALE/15781 IDO INTOKO D3 ELEKTRONIKA 4
180 1409/JOG/JF/D3/ALE/15783 JUMHADI WIJAYANTO D3 ELEKTRONIKA 4
181 1409/JOG/JF/D3/ALE/15784 LANDUNG CAHYONO D3 ELEKTRONIKA 4
182 1409/JOG/JF/D3/ALE/15797 RIO AJI SAPUTRA RIYANTO D3 ELEKTRONIKA 4
183 1409/JOG/JF/D3/ALE/15799 RUDY SEPTIYAWAN D3 ELEKTRONIKA 4
184 1409/JOG/JF/D3/ALE/15800 SATRIA DIMAS SAPUTRA D3 ELEKTRONIKA 4
185 1409/JOG/JF/D3/ALE/15802 TAUFIQ HIDAYAT D3 ELEKTRONIKA 4
186 1409/JOG/JF/D3/ALE/15803 TRI SANTIKO WIDODO D3 ELEKTRONIKA 4
187 1409/JOG/JF/D3/SIP/15809 AFNI IBNA GHORIBUDDIN D3 SIPIL 4
188 1409/JOG/JF/D3/SIP/15812 AGUS BUDI SETIAWAN D3 SIPIL 4
189 1409/JOG/JF/D3/SIP/15813 AGUS CATUR PAMBUDI D3 SIPIL 4
190 1409/JOG/JF/D3/SIP/15816 ANDIKA LAKSONO PUTERA D3 SIPIL 4
191 1409/JOG/JF/D3/SIP/15818 ARDY RAHMA SAPUTRA D3 SIPIL 4
192 1409/JOG/JF/D3/SIP/15819 ARIF KRISTANTO D3 SIPIL 4
193 1409/JOG/JF/D3/SIP/15820 AULIYA FUAD ZAMZAMI D3 SIPIL 4
194 1409/JOG/JF/D3/SIP/15826 DUWI HARIYANTO D3 SIPIL 4
195 1409/JOG/JF/D3/SIP/15830 FERRY KURNIAWAN D3 SIPIL 4
196 1409/JOG/JF/D3/SIP/15836 HADA MUSAKIM D3 SIPIL 4
197 1409/JOG/JF/D3/SIP/15849 MUCHAMAD ALFIN RIZKA ALHADI D3 SIPIL 4
198 1409/JOG/JF/D3/SIP/15851 MUHAMMAD RAJIF HUSAIN D3 SIPIL 4
199 1409/JOG/JF/D3/SIP/15852 MUSTAGHFIRIN D3 SIPIL 4
200 1409/JOG/JF/D3/SIP/15854 POBY RISTA YUHANDA D3 SIPIL 4
201 1409/JOG/JF/D3/SIP/15855 PRADITYA WIRADIPATI NUR FATAH D3 SIPIL 4
202 1409/JOG/JF/D3/SIP/15861 SAEFUL AMRI D3 SIPIL 4
203 1409/JOG/JF/D3/SIP/15863 SEPTIAN BAGUS PERKASA D3 SIPIL 4
204 1409/JOG/JF/D3/SIP/15864 SUTIKNO D3 SIPIL 4
205 1409/JOG/JF/D3/SIP/15865 TAUFIQUR ROHMAN D3 SIPIL 4
JAKARTA, 24 OKTOBER 2014 TIM REKRUTMEN
1
FORMULIR ANAMNESA CALON PEGAWAI
Lokasi Tes : ___________________ Tanggal : ___________________
Nomor Lab. : ___________________ (Kolom ini diisi petugas) IDENTITAS PESERTA
1. Nama :
2. No. Tes :
3. Jenis Kelamin : Laki-Laki / Perempuan *) 4. Tempat/Tgl Lahir :
5. Status : Kawin / Duda / Janda / Belum Menikah*)
6. Alamat : ________________________________________________________________ ________________________________________________________________
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 Ya Tidak Tdk Tahu
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
PT PLN (PERSERO)
2
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. Pengobatan jangka waktu yang lama: pernah / tidak pernah *)
Penyakit apa: _____________ Kapan: ____________ Jenis obat : ___________________ 3. Riwayat Merokok :
a. Jumlah : ____ batang / hari b. Mulai Merokok : _______________ 4. Riwayat konsumsi alkohol :
a. Jumlah : ________ gelas / sloki / botol / hari b. Mulai konsumsi : _____________________________ c. Jenis : _____________________________ 5. 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 ____________ 6. 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. Pola makan / diet khusus : _______________________________
2. Olah raga : Jenis ___________ Rutin / Tidak Rutin*) Frekuensi / minggu*) ____________ 3. Lain-Lain : ____________________________________________________________________
3 Demikian keterangan di atas Saya berikan dengan sesungguhnya dan saya bersedia dinyatakan gugur dalam seleksi PLN jika ternyata Saya memberikan keterangan yang tidak benar.
__________ , _________
2014Mengetahui, Peserta Seleksi
Dokter Pemeriksa
( ) ( )