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INTERNSHIP APPLICATION FORM
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SEKOLAH TINGGI PARIWISATA SAHID
Jl. Kemiri No. 22 Pondok Cabe
Tlp. 021-7402329
Fax.021-7428152
CONFIDENTIAL
Educational
Institution: SAHID INSTITUTE OF TOURISM
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Major: TOUR AND
TRAVEL
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1. POSITION APPLIED FOR (Please state in order of preference)
(a)
MICE
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(b)
EO
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LOCATION
/REGION/COUNTRY
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(a) Yogyakarta
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2. PERSONAL PARTICULARS
Name (Underline Surname): Rizky Idrus Setiadi
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Student Number (NIM): 2012245011
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Home Address : Jl.kemiri
no 22 Pondok Cabe
E-mail Address : riskiidrus26@yahoo.com
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Phone. No : 085276610757
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IC/Passport No.
Date of Expire :
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Date of Birth: Nopember
26, 1994
Place of Birth: Aceh
Tengah
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Age:
17
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Sex: Male
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Race: Javanese
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Country of Birth: Indonesia
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Citizenship: Indonesian
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Religion : Islam
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Marital Status: Single
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Academic Assist. Lecturer :
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Height : 167 cm
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Weight : 49
kg
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3. IMMEDIATE FAMILY MEMBERS
Name
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Relationship
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Age
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Occupation
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Company & Tel. No.
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Suradi S.E
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Father
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46
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Civil
Servant
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08537165151
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Sunarsih
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Mother
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41
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Civil
Servant
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08527010738
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Rina Sastri
liana
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Sister
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18
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Student
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-
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Sahril Octavian
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Brother
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5
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-
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-
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4. PERSON TO BE CONTACTED IN CASE OF EMERGENCY
Name
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Relationship
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Tel.
No
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Occupation
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Company
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Suradi S.E
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Father
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08537165151.
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Civil Servant
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Police Station
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Name
& Address of Employer
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Period
of training
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Position
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5. EDUCATION BACKGROUND (Begin with last
study)
6. EMPLOYMENT/TRAINING HISTORY (Begin with last employment/training)
From
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To
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Highest Standard Obtained
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SDN 1 Takengon
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2000
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2006
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The 2nd winner of distric speech competition.
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SMPN 4 Takengon
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2006
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2009
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The runner up of province painting competition.
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SMAN 4 RSBI Takengon
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2009
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2012
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The 4th winner of national sosiodramatic
competition.
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7. LANGUAGE/DIALECT
PROFICIENCY (Please tick)
Language
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Spoken
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Written
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Understanding
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English
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ü
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ü
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ü
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Japanese
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ü
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ü
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ü
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Mandarin
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ü
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ü
|
ü
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French
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ü
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ü
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ü
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8. MEDICAL HISTORY (Please tick)
Do you have any Physical Disabilities?
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Yes ( ) No ( √ )
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Have you ever undergo any medical operation before?
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Yes ( ) No ( √ )
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If yes, please specify in detail:
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9. GENERAL (Please tick)
Details
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No
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Yes
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If Yes, Please provide details unless
stated otherwise.
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Have
you ever been dismissed from employment/training because of poor work
performance or misconduct?
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ü
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Have
you been arrested or convicted for any offence?
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ü
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Are you
in debt?
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Have you studied for at least one
year in the hospitality school you are currently enrolled in? (Provide details only for No)
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ü
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10. DECLARATION
I authorize Sahid
Institute of Tourism to secure any information from myself and I hereby
release any person, firm or institution of all liability for any damage
whatsoever issuing from such information. I further declare that the
statements made by me are true, correct and complete. A false statement or
dishonest answer to any question may be grounds for my immediate discharge
from employment/internship with Industry.
Tanggerang Selatan, 22 march 2013
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