Photograph

INTERNSHIP APPLICATION FORM

Personal Data
Name

Nickname

Place/Birth date

Religion

Address

Marital Status

ID Number
(KTP/Passport)
Tax Number (NPWP)

Bank Mandiri Account Account Number:

Student Number

Telephone Home:

Mobile:

Email

Emergency Contact Name:

Phone:

Address:
Physical Condition
State if there is any physical disability

State if you have any major illness/accident in the

last six months

State your weight and height

State your blood type

Family Data
Relation Name Birth date Occupation
Spouse

Child (1)

Child (2)

Child (3)

Father

Mother

Sister (1)

Sister (2)

Sister (3)

Brother (1)

Brother (2)

Brother (3)
Education (list from latest education)
School/University Major Year GPA/Honors

Professional Qualifications Achieved

Professional Licenses/Certification Year Institution

Training/Course/Seminar/Program
Training/Course/Seminar/Program Year Institution
Languages
Language Proficiency Qualification (TOEFL/TOEIC/etc)
Bahasa

English

Mandarin

Personality
Describe your strength and
weakness

Describe what activities &

interest do you have

Describe achievement/things
that you are proud of

Describe your family

background

Organizational Background
Organization Name Position Year
References
Name Address Telephone Occupation

Work Function Interest (sort three)

Capital Market
Investment Banking
Equity Research
Fixed Income Research
Economic Research
Strategy & Performance
Accounting/Settlement
Corporate Communication
Human Capital/Human Resource
Information Technology
Risk Management/Legal/Compliance

Time to Internship Program (tick one)

√ Duration Availability Join Date*
2 Months From to
3 Months From to
More than 3 Months From to
*please take attention when deciding joining date. Join date mean the date that you available to start your internship program
(exclude duration). Sample; if you inform your availability join date from 29-31 July with 2 months duration, we will assume your
requested internship period by 29 July – 28 September or 31 July – 30 September.

______________________ ______________________
Signature & Name Date
Attach a photo/scanned of your ID card or passport here
(First identity page and last page for passport)

Attach a photo/scanned of first page of your Bank Mandiri bankbook

Describe what is your purpose and expectation for internship program
 Photograph
APPLICATION SUMMARY

Name
Place/Birth date
Address
ID No (KTP/Passport)
Tax Number (NPWP)
Bank Mandiri Account Account Number:
Student Number
Telephone Home:
Mobile:
Email

Last Education
School/University Major Year GPA/Honors

References
Name Address Telephone Occupation

Work Function Interest (sort three)

1
2
3

Time to Internship Program (tick one)

Duration Availability Join Date*
…… Months From to
*please take attention when deciding joining date. Join date mean the date that you available to start your internship program
(exclude duration). Sample; if you inform your availability join date from 29-31 July with 2 months duration, we will assume your
requested internship period by 29 July – 28 September or 31 July – 30 September.

______________________ ______________________
Signature & Name Date