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BARISTA POINT COFEE
PENGISIAN MENGGUNAKAN HURUF KAPITAL
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JENIS KELAMIN
PRIA
WANITA
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NAMA
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NIK
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ALAMAT ( JALAN / DUSUN, RT / RW / KELURAHAN/ KECAMATAN )
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KABUPATEN
Jombang
Kota Mojokerto
kabupaten Mojokerto
Kediri
Blitar
Trenggalek
Nganjuk
Madiun
Ponorogo
Magetan
Ngawi
Bojonegoro
Blora
Tulungagung
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TANGGAL LAHIR
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MM
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DD
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YYYY
NOMOR WA
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STATUS
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BELUM KAWIN
KAWIN
CERAI
JANDA / DUDA
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TINGGI BADAN
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BERAT BADAN
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USIA
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RIWAYAT SAKIT
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ASMA
HEPATITIS
TBC
JANTUNG
EPILEPSI
ALERGI
TIDAK PERNAH
APAKAH ANDA BERSEDIA DITEMPATKAN SESUAI KEBUTUHAN CABANG ?
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YA
TIDAK
AGAMA
ISLAM
KRISTEN
KATOLIK
HINDU
BUDDHA
KONGHUCU
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PENGALAMAN BEKERJA ( BARISTA )
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