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Formulir

http://www.prudentschool.sch.id

	PANITIA PENERIMAAN SISWA BARU YAYASAN PENDIDIKAN ADHI PUTRA SMK Prudent School d/h. Pelita Bangsa (Manajemen Perkantoran - Terakreditasi A) JL. KH. Hasyim Ashari/Tugu Karya No.78, Poris Piawad Utara - Cipondoh - Kota Tangerang No. Telp : 021-5548883, Fax : 021-55703527, Website : www.prudentschool.sch.id, E-mail : info@prudenshool.sch.id

DATA SISWA
SISWA
Nama Lengkap Siswa		:
(sesuai ijazah SD / SMP)
Nomer Induk Siswa Nasional		:
Nama Lengkap Siswa		:
Tempat dan Tanggal Lahir		:
Jenis Kelamin		:	1. Laki Laki 2. Perempuan
Agama		:	1. Islam 2. Kristen Protestan 3. Kristen Katolik 4. Hindu 5. Budha
Anak ke		:	dari bersaudara
Alamat Siswa		:	RT RW
			Kelurahan Kecamatan Kota/Kab
			No. Telp Handphone Kode Pos
			(wajib di isi)
SEKOLAH SEBELUMNYA
Nama Sekolah		:
Alamat Sekolah		:
Nomer Ijazah SD/SMP		:	Tahun Ijazah
Nomer SKHUN SD/SMP		:	Tahun Ijazah

ORANG TUA
Nama Orang Tua
a. Ayah		:
b. Ibu		:
Alamat Orang Tua		:	RT RW
			Kelurahan Kecamatan Kota/Kab
			No. Telp Handphone Kode Pos
Pekerjaan Orang Tua
a. Ayah		:	1. TNI/Polri 2. PNS 3. Peg. Swasta 4. Guru 5. Wiraswata 6. Lainnya
a. Ibu		:	1. TNI/Polri 2. PNS 3. Peg. Swasta 4. Guru 5. Wiraswata 6. Lainnya
Pendidikan Orang Tua
a. Ayah		:	1. SD 2. SMP 3. SMA 4. Diploma 5. Sarjana 6. Lainnya
b. Ibu		:	1. SD 2. SMP 3. SMA 4. Diploma 5. Sarjana 6. Lainnya

Wali
Nama Wali		:
Hubungan dengan Wali		:	1. Kakek/Nenek 2. Paman/Bibi 3. Kakak 4. Lainnya
Alamat Wali		:	RT RW
			Kelurahan Kecamatan Kota/Kab
			No. Telp Handphone Kode Pos
Pekerjaan Wali		:	1. TNI/Polri 2. PNS 3. Peg. Swasta 4. Guru 5. Wiraswata 6. Lainnya
Pendidikan Terakhir Wali		:	1. SD 2. SMP 3. SMA 4. Diploma 5. Sarjana 6. Lainnya

				Tanggerang 2010
			Orang Tua	Calon Siswa

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<body>
<p class="style1">
http://www.prudentschool.sch.id</p>
<table width="100%" border="0">
<tr>
    <td width="190"><img src="logo.JPG" width="125" height="125" /></td>
    <td colspan="4" class="style1">
  <span class="style11">PANITIA PENERIMAAN SISWA BARU</span> <br/>
  <span class="style5">YAYASAN PENDIDIKAN ADHI PUTRA</span> <br/>
  <span class="style7">SMK Prudent School d/h. Pelita Bangsa (Manajemen Perkantoran - Terakreditasi A) </span><br/>
  <span class="style10">JL. KH. Hasyim Ashari/Tugu Karya No.78, Poris Piawad Utara - Cipondoh - Kota Tangerang <br/>
  No. Telp : 021-5548883, Fax : 021-55703527, Website : www.prudentschool.sch.id, E-mail : info@prudenshool.sch.id </span><br/>    </td>
  </tr>
<tr>
    <td colspan="5"><hr/></td>
  </tr>
<tr>
    <td height="29" colspan="5"><div align="center" class="style12">
      DATA SISWA </div>
</td>
  </tr>
<tr>
    <td height="26" colspan="5"><span class="style14">SISWA</span></td>
  </tr>
<tr>
    <td height="21" colspan="2"><span class="style15">Nama Lengkap Siswa </span></td>
    <td width="30"><span class="style15">:</span></td>
    <td colspan="2"><input name="nama_lengkap" type="text" width="500"/></td>
  </tr>
<tr>
    <td height="21" colspan="5"><span class="style15">(sesuai ijazah SD / SMP)</span></td>
  </tr>
<tr>
    <td height="21" colspan="2"><span class="style15">Nomer Induk Siswa Nasional </span></td>
    <td><span class="style15">:</span></td>
    <td colspan="2"><input name="nama_lengkap" type="text" width="500"/></td>
  </tr>
<tr>
    <td height="21" colspan="2"><span class="style15">Nama Lengkap Siswa </span></td>
    <td><span class="style15">:</span></td>
    <td colspan="2"><input name="nama_lengkap" type="text" width="500"/></td>
  </tr>
<tr>
    <td height="21" colspan="2"><span class="style15">Tempat dan Tanggal Lahir </span></td>
    <td><span class="style15">:</span></td>
    <td colspan="2"><input name="nama_lengkap" type="text" width="500"/></td>
  </tr>
<tr>
    <td height="21" colspan="2"><span class="style15">Jenis Kelamin </span></td>
    <td><span class="style15">:</span></td>
    <td colspan="2"><span class="style15">
      <input type="text" name="nama_lengkap" width="25"/>
   1. Laki Laki      2. Perempuan </span></td>
  </tr>
<tr>
    <td height="21" colspan="2"><span class="style15">Agama</span></td>
    <td><span class="style15">:</span></td>
    <td colspan="2"><span class="style15">
      <input type="text" name="nama_lengkap" width="25"/>
   1. Islam    2. Kristen Protestan    3. Kristen Katolik    4. Hindu     5. Budha</span></td>
  </tr>
<tr>
    <td height="21" colspan="2"><span class="style15">Anak ke </span></td>
    <td><span class="style15">:</span></td>
    <td colspan="2"><span class="style15">
      <input type="text" name="nama_lengkap2" width="50"/>
     dari 
    <input type="text" name="nama_lengkap3" width="50"/>
 bersaudara</span></td>
  </tr>
<tr>
    <td height="21" colspan="2"><span class="style15">Alamat Siswa </span></td>
    <td><span class="style15">:</span></td>
    <td colspan="2"><span class="style15">
      <input type="text" name="nama_lengkap342" width="350"/> 
       RT 
       <input type="text" name="nama_lengkap2" width="50"/>
       RW 
      <input type="text" name="nama_lengkap3" width="50"/>
    </span></td>
  </tr>
<tr>
    <td height="21" colspan="2"> </td>
    <td> </td>
    <td colspan="2"><span class="style15">Kelurahan 
      <input name="nama_lengkap32" type="text" width="150"/>
    Kecamatan 
    <input type="text" name="nama_lengkap33" width="150"/>
     Kota/Kab 
     <input type="text" name="nama_lengkap34" width="150"/>
    </span></td>
  </tr>
<tr>
    <td height="21" colspan="2"> </td>
    <td> </td>
    <td colspan="2"><span class="style15">No. Telp 
        <input name="nama_lengkap32" type="text" width="150"/>
      Handphone
      <input name="nama_lengkap33" type="text" width="150"/>
      Kode Pos
      <input type="text" name="nama_lengkap34" width="150"/>
    </span></td>
  </tr>
<tr>
    <td height="21" colspan="2"><span class="style15"></span></td>
    <td><span class="style15"></span></td>
    <td colspan="2"><span class="style15">                                                                            </span> <span class="style15">            (wajib di isi) </span></td>
  </tr>
<tr>
    <td height="26" colspan="5"><span class="style14">SEKOLAH SEBELUMNYA </span></td>
  </tr>
<tr>
    <td height="21" colspan="2"><span class="style15">Nama Sekolah </span></td>
    <td><span class="style15">:</span></td>
    <td colspan="2"><input name="nama_lengkap" type="text" width="500"/></td>
  </tr>
<tr>
    <td height="21" colspan="2"><span class="style15">Alamat Sekolah </span></td>
    <td><span class="style15">:</span></td>
    <td colspan="2"><input name="nama_lengkap" type="text" width="500"/></td>
  </tr>
<tr>
    <td height="21" colspan="2"><span class="style15">Nomer Ijazah SD/SMP </span></td>
    <td><span class="style15">:</span></td>
    <td colspan="2"><span class="style15">
      <input type="text" name="nama_lengkap" width="350"/>
     Tahun Ijazah 
     <input type="text" name="nama_lengkap4" width="150"/>
    </span></td>
  </tr>
<tr>
    <td height="21" colspan="2"><span class="style15">Nomer SKHUN SD/SMP </span></td>
    <td><span class="style15">:</span></td>
    <td colspan="2"><span class="style15">
      <input type="text" name="nama_lengkap" width="350"/>
      Tahun Ijazah
      <input type="text" name="nama_lengkap4" width="150"/>
    </span></td>
  </tr>
<tr>
    <td height="21" colspan="2"><span class="style15"></span></td>
    <td><span class="style15"></span></td>
    <td colspan="2"><span class="style15"></span></td>
  </tr>
<tr>
    <td height="26" colspan="5"><span class="style14">ORANG TUA  </span></td>
  </tr>
<tr>
    <td height="21" colspan="2"><span class="style15">Nama Orang Tua </span></td>
    <td><span class="style15"></span></td>
    <td colspan="2"><span class="style15"></span></td>
  </tr>
<tr>
    <td height="21" colspan="2"><span class="style15">a. Ayah </span></td>
    <td><span class="style15">:</span></td>
    <td colspan="2"><input name="nama_lengkap5" type="text" width="500"/></td>
  </tr>
<tr>
    <td height="21" colspan="2"><span class="style15">b. Ibu </span></td>
    <td><span class="style15">:</span></td>
    <td colspan="2"><input name="nama_lengkap5" type="text" width="500"/></td>
  </tr>
<tr>
    <td height="21" colspan="2"><span class="style15">Alamat Orang Tua </span></td>
    <td><span class="style15">:</span></td>
    <td colspan="2"><span class="style15">
      <input type="text" name="nama_lengkap342" width="350"/>
       RT 
      <input type="text" name="nama_lengkap2" width="50"/>
       RW 
      <input type="text" name="nama_lengkap3" width="50"/>
    </span></td>
  </tr>
<tr>
    <td height="21" colspan="2"> </td>
    <td> </td>
    <td colspan="2"><span class="style15">Kelurahan
      <input name="nama_lengkap32" type="text" width="150"/>
      Kecamatan
      <input type="text" name="nama_lengkap33" width="150"/>
      Kota/Kab
      <input type="text" name="nama_lengkap34" width="150"/>
    </span></td>
  </tr>
<tr>
    <td height="21" colspan="2"> </td>
    <td> </td>
    <td colspan="2"><span class="style15">No. Telp
      <input name="nama_lengkap32" type="text" width="150"/>
      Handphone
      <input name="nama_lengkap33" type="text" width="150"/>
      Kode Pos
      <input type="text" name="nama_lengkap34" width="150"/>
    </span></td>
  </tr>
<tr>
    <td height="21" colspan="2"><span class="style15">Pekerjaan Orang Tua </span></td>
    <td><span class="style15"></span></td>
    <td colspan="2"><span class="style15"></span></td>
  </tr>
<tr>
    <td height="21" colspan="2"><span class="style15">a. Ayah </span></td>
    <td><span class="style15">:</span></td>
    <td colspan="2"><span class="style15">
      <input type="text" name="nama_lengkap" width="25"/>
         1. TNI/Polri    2. PNS    3. Peg. Swasta    4. Guru     5. Wiraswata     6. Lainnya 
      <input type="text" name="nama_lengkap343" width="150"/>
    </span></td>
  </tr>
<tr>
    <td height="21" colspan="2"><span class="style15">a. Ibu </span></td>
    <td><span class="style15">:</span></td>
    <td colspan="2"><span class="style15">
      <input type="text" name="nama_lengkap" width="25"/>
         1. TNI/Polri    2. PNS    3. Peg. Swasta    4. Guru     5. Wiraswata     6. Lainnya
      <input type="text" name="nama_lengkap343" width="150"/>
    </span></td>
  </tr>
<tr>
    <td height="21" colspan="2"><span class="style15">Pendidikan  Orang Tua </span></td>
    <td><span class="style15"></span></td>
    <td colspan="2"><span class="style15"></span></td>
  </tr>
<tr>
    <td height="21" colspan="2"><span class="style15">a. Ayah </span></td>
    <td><span class="style15">:</span></td>
    <td colspan="2"><span class="style15">
      <input type="text" name="nama_lengkap" width="25"/>
         1. SD    2. SMP    3. SMA    4. Diploma     5. Sarjana     6. Lainnya
      <input type="text" name="nama_lengkap343" width="150"/>
    </span></td>
  </tr>
<tr>
    <td height="21" colspan="2"><span class="style15">b. Ibu </span></td>
    <td><span class="style15">:</span></td>
    <td colspan="2"><span class="style15">
      <input type="text" name="nama_lengkap" width="25"/>
         1. SD    2. SMP    3. SMA    4. Diploma     5. Sarjana     6. Lainnya
      <input type="text" name="nama_lengkap343" width="150"/>
    </span></td>
  </tr>
<tr>
    <td height="21" colspan="2"><span class="style15"></span></td>
    <td><span class="style15"></span></td>
    <td colspan="2"><span class="style15"></span></td>
  </tr>
<tr>
    <td height="26" colspan="5"><span class="style14">Wali</span></td>
  </tr>
<tr>
    <td height="21" colspan="2"><span class="style15">Nama Wali </span></td>
    <td><span class="style15">:</span></td>
    <td colspan="2"><input name="nama_lengkap5" type="text" width="500"/></td>
  </tr>
<tr>
    <td height="21" colspan="2"><span class="style15">Hubungan dengan Wali </span></td>
    <td><span class="style15">:</span></td>
    <td colspan="2"><span class="style15">
      <input type="text" name="nama_lengkap" width="25"/>
         1. Kakek/Nenek    2. Paman/Bibi    3. Kakak   4. Lainnya
      <input type="text" name="nama_lengkap343" width="150"/>
    </span></td>
  </tr>
<tr>
    <td height="21" colspan="2"><span class="style15">Alamat Wali </span></td>
    <td><span class="style15">:</span></td>
    <td colspan="2"><span class="style15">
      <input type="text" name="nama_lengkap342" width="350"/>
       RT 
      <input type="text" name="nama_lengkap2" width="50"/>
       RW 
      <input type="text" name="nama_lengkap3" width="50"/>
    </span></td>
  </tr>
<tr>
    <td height="21" colspan="2"> </td>
    <td> </td>
    <td colspan="2"><span class="style15">Kelurahan
      <input name="nama_lengkap32" type="text" width="150"/>
      Kecamatan
      <input type="text" name="nama_lengkap33" width="150"/>
      Kota/Kab
      <input type="text" name="nama_lengkap34" width="150"/>
    </span></td>
  </tr>
<tr>
    <td height="21" colspan="2"> </td>
    <td> </td>
    <td colspan="2"><span class="style15">No. Telp
      <input name="nama_lengkap32" type="text" width="150"/>
      Handphone
      <input name="nama_lengkap33" type="text" width="150"/>
      Kode Pos
      <input type="text" name="nama_lengkap34" width="150"/>
    </span></td>
  </tr>
<tr>
    <td height="21" colspan="2"><span class="style15">Pekerjaan Wali </span></td>
    <td><span class="style15">:</span></td>
    <td colspan="2"><span class="style15">
      <input type="text" name="nama_lengkap" width="25"/>
         1. TNI/Polri    2. PNS    3. Peg. Swasta    4. Guru     5. Wiraswata     6. Lainnya
      <input type="text" name="nama_lengkap343" width="150"/>
    </span></td>
  </tr>
<tr>
    <td height="21" colspan="2"><span class="style15">Pendidikan Terakhir Wali </span></td>
    <td><span class="style15">:</span></td>
    <td colspan="2"><span class="style15">
      <input type="text" name="nama_lengkap" width="25"/>
         1. SD    2. SMP    3. SMA    4. Diploma     5. Sarjana     6. Lainnya
      <input type="text" name="nama_lengkap343" width="150"/>
    </span></td>
  </tr>
<tr>
    <td height="21" colspan="2"><span class="style15"></span></td>
    <td><span class="style15"></span></td>
    <td colspan="2"><span class="style15"></span></td>
  </tr>
<tr>
    <td height="21" colspan="2"><span class="style15"></span></td>
    <td><span class="style15"></span></td>
 <td width="478"><span class="style15"></span></td>
    <td width="289"><div align="right" class="style15">
Tanggerang
        <input type="text" name="nama_lengkap3432" width="150"/>
    2010 </div>
</td>
  </tr>
<tr>
    <td height="21" colspan="2"><span class="style15"></span></td>
    <td><span class="style15"></span></td>
    <td><div align="center" class="style15">
Orang Tua </div>
</td>
    <td><div align="center" class="style15">
Calon Siswa </div>
</td>
  </tr>
<tr>
    <td height="21" colspan="2"><span class="style15"></span></td>
    <td><span class="style15"></span></td>
    <td><span class="style15"></span></td>
    <td><span class="style15"></span></td>
  </tr>
<tr>
    <td height="21" colspan="2"><span class="style15"></span></td>
    <td><span class="style15"></span></td>
    <td><span class="style15"></span></td>
    <td><span class="style15"></span></td>
  </tr>
<tr>
    <td height="21" colspan="2"><span class="style15"></span></td>
    <td><span class="style15"></span></td>
    <td><div align="center" class="style15">
<hr width="120">
</div>
</td>
    <td><div align="center" class="style15">
      <hr width="120">
    </div>
</td>
  </tr>
</table>
<p class="style1">
 </p>
</body>
</html>

Myfile Nhm

Rabu, 22 April 2015

quis formulir Biodata Siswa

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