PT.

Asuransi Allianz Life Indonesia Photo

PT. Asuransi Allianz Utama Indonesia (3 x 4)

Job Application Form (JAF)

* This application should be completed in applicant's own handwriting.
** Please tick() in the appropriate box below and fill in the information accordingly.
Position Applied Availability

How do you know Allianz ? Are you willing to be relocated

Campus - To other Cities? Yes No
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Job Street / DB - To other Countries? Yes No
Head Hunter
Others

A1. PERSONAL INFORMATION

First Name Middle Name Last Name

Place of Birth Date of Birth Gender Male Female

Nationality Indonesian Others,

Religion Marital Status Blood Type

Moslem Single A

Christian Married B

Catholic Widow(er) AB

Buddhist O

Hindu

Others,

National ID No. (KTP) Passport No. Tax ID Registration No. (NPWP)

Permanent Address

City Postal Code Country

Correspondence Address

City Postal Code Country

Home Telephone Mobile Telephone

Personal E-mail address

Have you previously applied for a job or worked with any Allianz company ? If Yes, Please specify the year of application/period of employment?

Yes No Year of Application Period of Employment

Position Applied Position

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A2. FORMAL EDUCATION
University / Institute
Name From To Degree GPA

Senior High School

Name From To Major

A3. PROFESSIONAL DEVELOPMENT COURSES

Name of Institution From To Place Certificate Obtained

A4. COMPUTER AND/OR PROGRAMMING PROFICIENCY

Knowledge Level

Microsoft Words Beginner Intermediate Advance

Microsoft Excel Beginner Intermediate Advance

Microsoft Power Point Beginner Intermediate Advance

Others(Please Specify) Beginner Intermediate Advance

Programming Skills

A5. LANGUAGE PROFICIENCY

Languages Speaking Writing

Indonesian Beginner Intermediate Advance Beginner Intermediate Advance

English Beginner Intermediate Advance Beginner Intermediate Advance

German Beginner Intermediate Advance Beginner Intermediate Advance

Others: Beginner Intermediate Advance Beginner Intermediate Advance

A6. ORGANIZATION ACTIVITIES

Organization/Club From - To Position and Activities

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A7. AWARDS / ACHIEVEMENTS
Awards / Achievements Year Remarks

A8. PREVIOUS EMPLOYMENT INCLUDING YOUR CURRENT EMPLOYMENT (START FROM YOUR RECENT COMPANY)
Year (From - To) Company Job Title Summary of Duties Reason for Leaving

A9. DRAW YOUR CURRENT POSITION IN YOUR COMPANY ORGANIZATION STRUCTURE

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A10. MEDICAL HISTORY

Have you been or are suffering from any physical disability, Yes Please Specify
impairment, disease, serious illness or on medication? No

When was the latest of your medical check-up?

A11. CRIMINAL

1. Have you ever been convicted in a court of law in any country? Yes No
2. Have you ever been dismissed or suspended from the service of any employment? Yes No
3. Have you ever been declared bankrupt? Yes No
4. Are you heavily indebted? (exceed 50% of basic salary) Yes No

B. FAMILY MEMBERS
B1. Spouse
Name of Spouse Date of Birth

Employment Status Not Working Working *

* if Spouse is working, please complete the following

Company's Name Occupation

B2. Children
Name Date of Birth Gender School / Institution

B3. Parents, Brothers & Sisters

Name Date of Birth Gender Relationship Occupation

C. EMERGENCY CONTACT
Name Address Home Ph. No./Mobile Ph. No. Relationship

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D. REFERENCES
Name Position Mobile Phone No. Relationship to Applicant

E. CONFLICT OF INTEREST
When answering these questions, please remember to take into consideration as appropriate your immediate and "Close family".
"Close family" shall include your spouse, domestic or civil partner, significant other, son, daughter, grandchild, parents, parents-in-law or other close
relatives or any person on your economic household or whom you make significant financial contribution to, close friends, business partners of your family
members.
1. Do you have any immediate family/relative that opetates or has financial interest in insurance agencies Yes No
with Allianz Indonesia or any direct or indirect business partnerships with Allianz Indonesia or other
insurance companies? (*)

2. Do you have any immediate family/relative who works as insurance agent/sales intermediaries of Allianz Yes No
Indonesia? (*)

3. Do you have any immediate family/relative who has business relationship with Allianz Indonesia (such as Yes No
vendor,etc)? (*)

4. Do you have any immediate family/relative who also works as employee of Allianz? (*) Yes No

(*) If you have answered "Yes" to any question above, please provide details below.

Details of Conflict of Interest

F. Declaration
I, hereby declare as follows:
1. that all the above information given by me are true and correct and declare to the best of my knowledge, none of these private or personal
interests conflict with any of my future official duties at Allianz Indonesia;
2. I understand that as part of the company's requirement to determine the suitability of an applicant for the position applied for, the Company
reserves the right at its absolute discretion to conduct the relevant background checks on me and when deemend necessary and that such
checks include but would not be limited to checks on credit worthiness, bankruptcy and criminal convictions. I further declare that I consent
to the same being conducted; and
3. that if I am employed, any false information given may render me liable to dismissal. This declaration shall, if I am employed by the Company,
constitute an integral part of any contract of service between the Company and myself.

SIGNATURE OF APPLICANT

Name Date

DOCUMENTS TO COMPLETE
Please submit the scan copy of the following documents:
(please make 1 (one) scan copy file for each document)
1. Curriculum Vitae (CV)
2. Diploma & Transcripts
3. Blue Background photo
4. National ID No. (KTP) or Passport No. for expatriates
5. Tax ID Registration No. (NPWP)
6. Kartu Keluarga (KK)
7. Married Certificate (if applicable)
8. Birth Certificate of dependents (if applicable)
9. Salary Slip from current Employer
10. Reference Letter from current Employer

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