YAYASAN RUMAH ENERGI

APPLICATION FORM

Do not write in
this space
INSTRUCTIONS
Please answer each question clearly and
completely. Type or print in ink. Read carefully and
follow all directions.

Position Applied For

1. Family Name
2. First Name
3. Present
Nationality
4. Address

Permane
nt
Present

Phone
Phone

Email
5. Employment Record

Starting with your present post, list in reverse order every employment you have had. Use
a separate block for each post. Include also service in the armed forces and note any period during which you were not gainfully
employed. If you need more space, attach additional pages of the same size. Give net salaries per month for your last or present
post.

Title of your post

Name of employer
Address of employer

Start date
Salaries per month (IDR)
Other Monetary Benefits
Other Non-Monetary
Benefits
Name of supervisor

End date

Start date
Salaries per month (IDR)
Other Monetary Benefits
Other Non-Monetary
Benefits
Name of supervisor

End date

Start date
Salaries per month (IDR)
Other Monetary Benefits
Other Non-Monetary
Benefits
Name of supervisor

End date

Start date

End date

Main responsibilities

Reason for leaving

Title of your post
Name of employer
Address of employer

Main responsibilities

Reason for leaving

Title of your post
Name of employer
Address of employer

Main responsibilities

Reason for leaving

Title of your post

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Name of employer
Address of employer

Salaries per month (IDR)

Other Monetary Benefits
Other Non-Monetary
Benefits
Name of supervisor

Main responsibilities

Reason for leaving

6. Preferred field to work
7. Expected monthly
compensation
8. Availability / Notice Period
Required
9. Would you accept employment for less than six months?
10. If you are disabled, please state whether you require any adjustments to be
made to facilitate your participation in the selection process. Human Resources

Yes
Yes

No
No

Yes

No

will contact you to discuss at a later date.

11. Have you previously submitted an application for employment with YRE?
If the answer is yes, when and for what position(s)?
12. Knowledge of
languages

Mother language
Other languages

13. Educational

Read
Easily
Not
Easily

Write
Easil
Not
y
Easily

Speak
Easil
Not
y
Easily

Understand
Easil
Not
y
Easily

(University or equivalent, please do not translate or equate to other degrees)

Name, Place and Country

Attended
(Month/Year)
From
To

Degrees

Main Course of Study

Attended
(Month/Year)
From
To

Type

Certificates

14. Other formal training or education

Name, Place and Country

15. Have you any objections to our making inquiries of your present employer?
Yes
No
16.References List three persons, not related to you, who are familiar with your character and qualifications.
Full Name
Full Address
Business or occupation

17. Have your ever been arrested, indicted, or summoned into court as a
Yes
No
defendant in a criminal proceeding, or convicted, fined or imprisoned for the
violation of any law (excluding minor traffic violations)? If yes, give full
particulars of each case in an attached statement.
I certify that the statements made by me in answer to the foregoing questions are true, complete and
correct to the best of my knowledge and belief. I understand that any misrepresentation or material
omission made on a Personal History form or other document requested by the Organization renders a
staff member of the Yayasan Rumah Energi liable to termination or dismissal.
Date:

Signature:
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