v1.

2 - 0618
Employee Application Form

FORMULIR CALON KARYAWAN

Harap diisi dan disimpan dalam format file PDF
EMPLOYMENT APPLICATION FORM
Please type and save as in PDF format

Keterangan tentang diri / Personal Particular

Nama Lengkap
Full Name
Alamat Saat Ini
Current Address
Alamat Sesuai KTP Please Insert Your Recent
Photograph in Blue
Home Address - ID background
Telepon Rumah / HP
Home Phone / Mobile
Alamat E-Mail
Email Adress

Tempat Tanggal Lahir Warga Negara

Place & Date of Birth Citizenship
Nomor KTP Golongan Darah
ID Card number Blood Type
Nomor NPWP Status Perkawinan
NPWP (Tax) Number Marital Status
Nomor Paspor Jml. Tanggungan Laki - laki
Passport Number Number of Children Perempuan

Pendidikan, Kursus, & Keterampilan / Education, Courses & Skills

A. Pendidikan Formal / Formal Education

Tingkat Lembaga Pendidikan &

Jurusan Thn Mulai Thn Selesai IPK
Pendidikan Kota Lulus / Tidak
Education Lvl Major Start End GPA
Institution & Place

PT Bayer Indonesia will not charge any cost from the candidate for the recruitment process.
Your personal data will be treated confidentially and will be used for recruitment purposes only 1
 v1.2 - 0618
Employee Application Form

B. Kursus-kursus & Pelatihan / Courses & Training

Tingkatan Pendidikan Lembaga & Kota Thn Mulai Th Selesai Ijazah
Level of Education Institution & Place Start End Certificate

C. Keterampilan Bahasa Asing & Komputer

Bahasa Asing Tingkat Keahlian Keahlian Komputer Tingkat Keahlian
Foreign Language Level of Availability Computer Skills Level of Availability
Ms. Office (Word,
English Powerpoint, Excel, Dll.)

D. Prestasi yang pernah diraih / Award you have achieved

Di Sekolah Tahun Di Tempat Kerja Tahun
At School Year At Office Year

Lingkungan Keluarga / Family Spouses

A. Susunan Keluarga / Blood Relatives (Termasuk diri Saudara / Including Yourself)

Posisi Nama Tgl. Lahir Pendidikan Terakhir Pekerjaan

Position Name Date of Birth Latest Education Occupation

Ayah
Father

Ibu
Mother

Anak 1
1st Child

Anak 2
2nd Child

Anak 3
3rd Child

PT Bayer Indonesia will not charge any cost from the candidate for the recruitment process.
Your personal data will be treated confidentially and will be used for recruitment purposes only 2
 v1.2 - 0618
Employee Application Form

Anak 4
4th Child

Anak 5
5th Child
B. Istri, Suami & Anak / Wife, Husband and Wife

Posisi Nama Tgl. Lahir Pendidikan Terakhir Pekerjaan

Position Name Date of Birth Latest Education Occupation

Suami
Husband

Istri
Wife

Anak 1
1st Child

Anak 2
2nd Child

Anak 3
3rd Child

Anak 4
4th Child

Anak 5
5th Child

Informasi Pekerjaan / Information About The Job

A. Pengalaman Kerja / Working Experience

Start
Nama Perusahaan Jabatan End (Month- Alasan Pindah
(Month-
Name of Company Position Year) Reason to Leave
Year)

Tulislah secara singkat tugas dan tanggung jawab Saudara pada jabatan terakhir / saat ini
Write down briefly about your duty and responsibility in the last / current position

1
2
3
4
5
6
7
8

Jabatan dari atasan langsung Saudara

PT Bayer Indonesia will not charge any cost from the candidate for the recruitment process.
Your personal data will be treated confidentially and will be used for recruitment purposes only 3
 v1.2 - 0618
Employee Application Form

Job title of your direct superior

Jabatan dari bawahan langsung Saudara

Job title of your direct sub ordinate

B. Hal-hal lain yang berhubungan dengan lamaran kerja / Other matters connected with
your application

1 Alasan meninggalkan perusahaan

Reason leaving the last company

2 Alasan / Tujuan Saudara melamar pekerjaan

Your motivation & reason to apply for the job in this company

3 Jabatan yang Saudara lamar di perusahaan

The job you are applying

4 Pekerjaan / Tugas yang saudara kuasai

Job / duties you are mastering

5 Siapa karyawan / karyawati yang Saudara kenal di perusahaan ini?

Who is / are employee(s) you acquainted in this company

6 Apa hubungan Antara Saudara dengan karyawan diatas?

What kind of relation between you and him / her

7 Dari mana Saudara mengetahui adanya informasi lowongan di perusahaan ini?

From where do you know about the vacancy in this company

8 Jenis Kendaraan yang saudara gunakan, kepemilikan kendaraan, SIM yang dimiliki?
Type of vehicle you are using,vehicle ownership,your driving license

9 Apakah Saudara bersedia bertugas keluar kota?

Are you ready to work outside of town

PT Bayer Indonesia will not charge any cost from the candidate for the recruitment process.
Your personal data will be treated confidentially and will be used for recruitment purposes only 4
 v1.2 - 0618
Employee Application Form

10 Apakah Saudara bersedia dipindahkan ke kota lain sesuai dengan kebutuhan perusahaan?
Are you ready to be relocated to other outside of town

11 Jika Saudara diterima, kapan saudara dapat mulai bekerja?

If you are appointed, when you will start to work

8 Kondisi dan Fasilitas yang diperoleh

Mohon tuliskan dalam perhitungan gross
Saat ini / Current Yang diharapkan / Expected
Gaji Pokok (Gross)
Rp Rp
Basic Salary (Gross)

THR (Tunjangan Hari

Rp Rp
Raya)

Bonus Akhir Tahun (Fixed) Rp Rp

Bonus Kinerja / Skema

Insentif

Tunjangan / Allowance

Asuransi / Insurance

Lain - lain / others

Saya bersedia melampirkan lampiran bukti berupa slip gaji / dokumen resmi lainnya

Referensi / Reference

Tuliskan 2 (dua) orang kenalan Saudara yang dapat dihubungi untuk referensi. Jangan cantumkan keluarga

Nama Perusahaan / Company Alamat / Adress Hubungan/Rel. Context

Name Jabatan / Position No. Telp / Phone Masa Perkenalan/Period

Years

Years

Lain - lain / Others

1 Apa hobby Saudara?

What is / are your hobbies

2 Apa yang Saudara lakukan pada waktu luang ?

What do you do in your leisure time

3 Bila ada kesempatan untuk memperdalam ilmu, bidang apa yang Saudara pilih ?
If there is opportunity to continue your education, what filed do you want to choose

4 Surat kabar / majalah apa yang Saudara baca ?

What newspaper / magazine do you read

PT Bayer Indonesia will not charge any cost from the candidate for the recruitment process.
Your personal data will be treated confidentially and will be used for recruitment purposes only 5
 v1.2 - 0618
Employee Application Form

5 Topik-topik apa yang Saudara minati ?

What do you do in your leisure time

Place Date
Dengan ini saya menyatakan bahwa seluruh informasi yang dinyatakan di
atas (“Informasi”) adalah benar dan selama diperbolehkan oleh undang –
undang saya memberikan persetujuan secara penuh tanpa bisa ditarik
kembali kepada PT Bayer Indonesia untuk dapat menggunakan Informasi
dalam keperluan proses rekrutmen dan administrasi HR terkait. Apabila
pernyataan-pernyataan saya di atas terkait Informasi terbukti tidak benar di
kemudian hari, Saya bersedia untuk diberhentikan seketika dan tanpa
mendapatkan pesangon dan/atau ganti rugi apapun.

I hereby confirm that all information given above (“Information”) are true
and If allowed by prevailing regulation I grant fully irrevocable consent to
PT Bayer Indonesia to utilize the Information for recruitment process
purposes and related HR Administration. If in the future my statements
above relating to Information are proven to be not true, I am willing to be
terminated immediately without any severance pay and/or any
compensation whatsoever.

(CANDIDATE NAME)
Applicants

PT Bayer Indonesia will not charge any cost from the candidate for the recruitment process.
Your personal data will be treated confidentially and will be used for recruitment purposes only 6