Form Training Slv
2
VAN-OVAN WELDING SCHOOL METROPOLITAN INDONESIA Specialist Training – Certification – Inspection – Consultant – Welding Engineering – NDT Service – Coating – Seismic Service Office : Pondok Cilegon Indah (PCI), Blok C-19 No.12A, Cilegon - Banten, Phone : +62-254- 376 997 Fax : +62-254- 396 501 BBM : 25DC512F E-mail : [email protected] FORMULIR PENDAFTARAN TRAINING 1. Nama Lengkap : _______________________________________________________________________ Umum Anggota API/IWS Alumni SLV /Mahasiswa / Pelajar ( Mohon sertakan Kartu Tanda Mahasiswa / Pelajar ) *) Beri tanda (√) disalah satu kolom 2. Tempat/tgl Lahir : _______________________________________________________________________ 3. No. Anggota API/IWS (jika ada) : _______________________________________________________________________ 4. Perusahaan/Institusi : _______________________________________________________________________ 5. Bidang Usaha Perusahaan/Institusi : _______________________________________________________________________ 6. Alamat : _______________________________________________________________________ _______________________________________________________________________ 7. No. Telp. / Fax : _______________________________________________________________________ 8. HP : _______________________________________________________________________ 9. E-mail : _______________________________________________________________________ 10. Pendidikan Formal Terakhir : _______________________________________________________________________
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Nomor
VAN-OVAN WELDING SCHOOL
METROPOLITAN INDONESIASpecialist Training Certification Inspection Consultant Welding Engineering NDT Service Coating Seismic Service
Office : Pondok Cilegon Indah (PCI), Blok C-19 No.12A, Cilegon - Banten, Phone : +62-254- 376 997 Fax : +62-254- 396 501 BBM : 25DC512F E-mail : [email protected]
SEKOLAH LAS VAN-OVAN
INDUSTRIAL TRAINING CENTER Specialist Training Certification Inspection Consultant Welding Engineering NDT Service Coating Seismic Service
Office : Pondok Cilegon Indah (PCI), Blok C-19 No.12A, Phone & Fax : (0254) 396501, Mobile : 085 6886 4985, 08777 1200 615E-mail : [email protected]
FORMULIR PENDAFTARAN TRAINING
1. Nama Lengkap
: _______________________________________________________________________
Umum
Anggota API/IWS
Alumni SLV /Mahasiswa / Pelajar ( Mohon sertakan Kartu Tanda Mahasiswa / Pelajar )
*) Beri tanda () disalah satu kolom2. Tempat/tgl Lahir
: _______________________________________________________________________3. No. Anggota API/IWS (jika ada)
: _______________________________________________________________________4. Perusahaan/Institusi
: _______________________________________________________________________5. Bidang Usaha Perusahaan/Institusi
: _______________________________________________________________________6. Alamat
: _______________________________________________________________________
_______________________________________________________________________7. No. Telp. / Fax
: _______________________________________________________________________8. HP
: _______________________________________________________________________9. E-mail
: _______________________________________________________________________10. Pendidikan Formal Terakhir
: _______________________________________________________________________11. Jenis Pelatihan
: Beri tanda () disalah satu kolom dan Keterangan tambahan bila ada
WELDER
WELDING INSPECTOR (Training SLV, BNSP, AWS, CSWIP) *Pilih salah satu NDT ................................................................
SAFETY ..........................................................
SERTIFIKASI ..................................................
LAINNYA .........................................................
Persyaratan:
Surat Keterangan Tidak Buta Warna / Eye Test (Jaeger 1 and Ishihara / Vision test dan buta warna) Menyerahkan Curiculum Vitae ( CV ) LENGKAP (FC. Ijazah Terakhir, FC.Surat Keterangan/Pengalaman Kerja dan FC. KTP) Menyerahkan Pas Photo berwarna Uk. 3x4 (4 Lembar); 4x6 (4 Lembar)
Membayar biaya pendaftaran Rp. 200.000,- dan Biaya Pelatihan yang akan diikutiPembayaran Via Transfer : Bank BCA , No. Rekening 2370149006 A/N HELMAN NOVRANDOSetelah melakukan transfer Hub Panitia dan Slip transfer dikirim via Email ke SLV.., . 20.
..
Tanda tangan & Nama Lengkap
