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T
IKET
P
ENERBANGAN
F
LIGHT
T
ICKET
I
DENTITASP
ENUMPANGP
ASSENGER’
SI
DENTITYDETAIL PENERBANGAN
FLIGHT DETAIL
Bandara Keberangkatan:
Departure Airport:
Bandara Ketibaan:
Arrival Airport: Hari, Tanggal:
Flight Code:
C
LASSIFICATIONC
HANGESChange
Old Information
New InformationTransfer: Title/Dept: Title/Dept:
Promotion: Title/Dept: Title/Dept:
Demotion: Title/Dept: Title/Dept:
Title: Title/Dept: Title/Dept:
Shift: Shift: Shift:
Location: Location: Location:
Salary: Salary: Salary:
Status: Status: Status:
Other changes:
Notice Of COBRA
Rights? Provided:Date
Election Of COBRA? Started:Date
A
DDITIONALC
OMPENSATION/B
ENEFITSI
NFORMATIONPlease List Any Additional Changes in Compensation or Benefits:
Please List Any Other Changes Not Listed Above: