PT. ANDALAN TIGA BERJAYA PT.

ASMIN BARA BRONANG

PT. ASMIN BARA JAAN OTHER

POSITION APPLIED :

SEX :

M F

FULL NAME :
(match with ID Card)

Photo (3 x 4)

(FILLED BY HR DEPARTMENT) NIK : FIRST DATE OF WORKING : EMPLOYMENT STATUS : DEPARTMENT CODE : DIVISION :

POSITION : PERSONAL LEVEL : SPK No. : INA BANK A/C No : DATE OF RESIGNATION : PERMANENT ADDRESS : .. .. POST CODE : .. PHONE .... CURRENT ADDRESS : .. POST CODE : .. PHONE ....

PLACE/DATE OF BIRTH : . HEIGHT : CM WEIGHT KG ID NUMBER : PASSPORT NUMBER : DRIVER LICENSE NO : KPA NO. : JAMSOSTEK NO. :

MATERIAL STATUS :

SINGLE

MARRIED

DIVORCED BLOOD TYPE :

NATIONALITY :

RELIGION : ..

EDUCATION : SCHOOL/UNIV. MASTER BACHELOR DIPLOMA SENIOR HIGH SCHOOL JUNIOR HIGH SCHOOL PRIMARY SCHOOL

NAME

ADDRESS

MAJOR/GPA FROM

TO

PASS/FAIL

STATE FOREIGN LANGUAGES YOU MASTER AND FILL IN YOUR LEVEL OF LANGUAGE MASTERY. LANGUAGE READING LISTENING SPEAKING 1 2 3

WRITING

REFERENCES : NAME 1 2 COMPANY ADDRESS/PHONE

LIST OF ACHIEVEMENTS.

ORGANIZATION

HOBBIES AND ACTIVITIES

FAMILY RELATIONSHIP. RELATION NAME

SEX (M/F)

DATE OF BIRTH (AGE)

HIGHEST EDUCATION

OCCUPATION POSITION COMPANY

FATHER MOTHER BROTHERS/SISTERS (INCLUDING YOURSELF) 1 2 3 4 5 6 SPOUSE CHILDREN 1 2 3 TRAINING/COURSES NAME OF TRAINING

INSTITUTION

VENUES

DURATION FROM UNTIL

FINANCED BY

1 2 3

4 5 6 7 8 9 EMPLOYMENT HISTORY : STATE YOUR EMPLOYMENT HISTORY AS COMPLETELY AND ACCURATELY AS POSSIBLE BEGINNING FROM THE PRESENT OR LAST EMPLOYMENT TO PREVIOUS ONES. 1. SERVICE YEARS YEARS MONTH FROM TO TYPE OF BUSINESS : LINE SUPERIOR : JOB DESCRIPTION OR DESCRIBE DUTIES AND RESPONSIBILITIES IN YOUR CURRENT/LAST POSITION : TOTAL EMPLOYEES : DIRECTOR : DESCRIBE THE ORGANIZATION STUCTURE SHOWING YOUR POSITION: NAMES/ADDRESS/PHONE OF COMPANY POSITION WORKING FIELD

2. SERVICE YEARS YEARS MONTH FROM TO TYPE OF BUSINESS : LINE SUPERIOR :

NAMES/ADDRESS/PHONE OF COMPANY

POSITION

WORKING FIELD

TOTAL EMPLOYEES : DIRECTOR : DESCRIBE THE ORGANIZATION STUCTURE SHOWING YOUR POSITION:

JOB DESCRIPTION OR DESCRIBE DUTIES AND RESPONSIBILITIES IN YOUR CURRENT/LAST POSITION :

3. SERVICE YEARS YEARS MONTH FROM TO TYPE OF BUSINESS : LINE SUPERIOR :

NAMES/ADDRESS/PHONE OF COMPANY

POSITION

WORKING FIELD

TOTAL EMPLOYEES : DIRECTOR : DESCRIBE THE ORGANIZATION STUCTURE SHOWING YOUR POSITION:

JOB DESCRIPTION OR DESCRIBE DUTIES AND RESPONSIBILITIES IN YOUR CURRENT/LAST POSITION :

4. SERVICE YEARS YEARS MONTH FROM TO TYPE OF BUSINESS : LINE SUPERIOR :

NAMES/ADDRESS/PHONE OF COMPANY

POSITION

WORKING FIELD

TOTAL EMPLOYEES : DIRECTOR : DESCRIBE THE ORGANIZATION STUCTURE SHOWING YOUR POSITION:

JOB DESCRIPTION OR DESCRIBE DUTIES AND RESPONSIBILITIES IN YOUR CURRENT/LAST POSITION :

PUT AN "" IN THE CORRECT RESPONSE BOX HAVE YOU PREVIOUSLY APPLIED TO OUR COMPANY/GROUP ? IF SO WHEN AND WHAT POSITION ? ARE YOU ALSO APPLYING TO OTHER COMPANIES ? IF YES PLEASE MENTION WHAT COMPANIES AND POSITION APPLIED? ARE YOU UNDER CONTRACT AGREEMENT WITH OTHER COMPANIES ? DO YOU HAVE ANY OBJECTIONS IF WE CONTACT YOUR PREVIOUS EMPLOYER FOR HAD IT ? DO YOU HAVE ANY ACQUAINTANCE (S) OR RELATIVE (S) EMPLOYED BY, OUR COMPANY/GROUP ? PLEASE MENTION NAME AND YOUR RWLATIONSHIP ?

YES

NO

REMARKS

WHAT SERIOUS ILLNESS/SURGERIES/ACCIDENTS HAVE YOU EVER HAD ? WHEN HAVE YOU HAD IT ? HAVE YOU EVER UNDERGONE ANY PSYCHOLOGICAL TEST BEFORE ? IF SO, WHEN, WHERE AND FOR WHAT PURPOSE ? HAVE YOU EVER BEEN INVOLVED IN ANY ADMINISTRATIVE, CIVIL OR CRIMINAL CASES ? IF ACCEPTED , DO YOU AGREE TO BE LOCATED ANYWHERE IN INDONESIA ? PLEASE MENTION THE PREFERRED CITIES OR REGIONS ! DESCRIBE ANY KIND OF JOBS THAT ARE IN LINE WITH YOUR CAREER PLAN ! PLEASE STATE YOUR CURRENT MONTHLY INCOME AND FACILITIES ? DESCRIBE ANY KIND OF JOBS THAT YOU DON'T LIKE ? STATE SALARY AND FACILITIES DESIRED ! IF ACCEPTED, WHEN CAN YOU START WORKING ?

HEREBY CERTIFY THAT THE INFORMATION GIVEN ABOVE IS TRUE AND IF UNDER ANY CIRCUMSTANCES, ANY MISREPRESENTATION OR OMISSION OF INFORMATION IS FOUND, I UNDERSTAND THAT I SHALL BE HELD RESPONSIBLE.

..20 .

( .) APPLICANT