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Dorm Exit Permit Form

This document is a dorm exit permit form that collects personal data from employees seeking to move out of company dormitories. It requires information such as name, department, badge number, address history, and reason for leaving the dorm, which can be for local hiring, becoming a permanent employee, or getting married. Different supporting documents are needed depending on the reason, such as certificates of residence, marriage certificates, family cards, and identity cards. The form must be approved by the unit leader, security, and HR to ensure all requirements are met before an employee can receive allowances and move out of the dormitory.

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Santi Sitohang
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© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
352 views

Dorm Exit Permit Form

This document is a dorm exit permit form that collects personal data from employees seeking to move out of company dormitories. It requires information such as name, department, badge number, address history, and reason for leaving the dorm, which can be for local hiring, becoming a permanent employee, or getting married. Different supporting documents are needed depending on the reason, such as certificates of residence, marriage certificates, family cards, and identity cards. The form must be approved by the unit leader, security, and HR to ensure all requirements are met before an employee can receive allowances and move out of the dormitory.

Uploaded by

Santi Sitohang
Copyright
© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
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DORM EXIT PERMIT FORM

PERSONAL DATA:
Dorm :_____________ Dept : ____________
Badge : : ____________ Joined Date : ____________
Name : ____________ Expired Date : ____________
Sex : ____________ Recruitment Place : ____________
Phone : ____________ Start Out from dorm : ____________

REASON DORMITORY OUTSIDE


Please Check List

□ Local Hiring □ Permanent □ Married

PREVIOUS ADDRESS : _____________________________________________________


(Please fiil units dorm)

CURRENT ADDRESS : ______________________________________________________


(Please fiil address your stay out dorm)

______________________________________________________

______________________________________________________

Batam,____/____/____

Request by, Aknowledge by, Cheked by, Approved by,


Employee Name Unit Leader Security Gate HR Officer

______________________ ______________________ ______________________ ______________________

Signature :_____________ Signature:_____________ Signature:_____________ Signature :_____________

Date : _____________ Date : _____________ Date : _____________ Date : _____________

This form special requariement data out dorm for:


Local Hiring Permanent employees Married employees
REQUIREMENTS OF DORMITORY EXIT PERMIT

A. Stay out (Local Hiring)


 Fill in dorm exit permit form Completed □
 Certificate of domicily (RT/RW) Completed □
 Transport Allowance Efective …………..

B. Stay out (Permanent)


 Fill in dorm exit permit form Completed □
 Certificate of domicily (RT/RW) Completed □
 Transport Allowance Efective …………..

C. Stay out (Married)


 Fill in dorm exit permit form Completed □
 Certificate of domicile (RT/RW) Completed □
 Copy marriage certificate Completed □
 Copy family card-husband/wife Completed □
 Copy identity card- husband/wife Completed □
 Copy BPJS Kes husband/wife Completed □
 Transport Allowance Efective …………..
 Housing Allowance Efective …………..
 Married Bonus Efective …………..

Note:
Submitted data before 10 will paid on 29
Submitted data after 10 will paid on next month

Cutt off data dorm :16 last month-15 current month (Dormitory Report)
Cutt off data allowance : 11 last month-10 current month (Allowances)

This form special requariement data out dorm for:


Local Hiring Permanent employees Married employees

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