PT.

SCG LIGHTWEIGHT CONCRETE INDONESIA

FORMULIR PENGISIAN DATA PELAMAR

APPLICATION FORM
,

Fill this job application form clearly, complete and detail specified.
All the questions must be filled correctly, if someday proven that the data is incorrect, then you
Considered giving fake information or information that have been forge and this process considered to be
Cancel.
Fill by hand writing or typing
Enclosed one Pas Photo with size 3X4
If you have question in filling this form, asked the recruiter.

Pas Photo
3x4

1. POSITION APPLIED
Position

: ______________________________________________________________________________

2. PERSONAL DATA
Full Name/ Nama Lengkap

: FIRMAN EKA SAPUTRA

Sex/ Jenis Kelamin

: Male / Female *)

(striketrough the unnecessary)

Date of Birth/ Tempat,Tgl Lahir: 15-041993 Place : KENDAL

Child/ Anak
(saudara)

Age/ Usia: 23

: Only child / First / Second / Third / ______ *) (striketrough the unnecessary)

from _____ siblings

Religion/ Agama

: ISLAM_______________________________Nation/ Kenegaraan : INDONESIA______________

Height/ Tinggi Badan

: 170

________________Cm Weight/ Berat Badan:

Blood Type/ Golongan Darah : 0 / A / B / AB *)

60__________________Kg

(strikethrough the unnecessary)

Last Education/ Pendidikan : Senior High School / Academy / University / Post Graduate *) (strikethrough the unnecessary)
Maritial Status/ Status

: Single / Married / Widower / Widow *)

Child Dependent

: ________________________________________________________________________ person

Hobbies/ Hobbi

: GAME,READING,JOGING_________________________________________________________

ID Card Number/ No. KTP

: 3325111504930005______________________________________________________________

NPWP Number

: ______________________________________________________________________________

Driving License/ SIM

: C / A / B I / B II (strikethrough the unnecessary) Driving Lisence No. : 920414270022_____________

(strikethrough the unnecessary)

Passport Number/ No. Pass : ______________________________________________________________________________

Shoe Number/ No. Sepatu

: 43_______________

Shirt Size/ Uk. Kemeja: S / M / L / XL Waistline: (celana) : 32_________

Current Address/ Alamat

: JL.PINES NO.14A RT 007/RW 001, DESA KALISALAK, KECAMATAN BATANG_______________

______________________________________________________________________________

Telephone

: Home _______________________________HP. 085786388997__________________________

E-Mail Address

: fsaputra64@gmail.com___________________________________________________________

In case of emergency, family, address, phone number that can be contacted:

Name

: farid ghozali___________________ Family Relation ( hubungan keluarga) : cousin____________

Job

: Nurse_________________________________________________________________________

Current Address
Telephone

: Kendal________________________________________________________________________
: Home ____________________________
HP. 085740697225_____________________
Page 1 of 4
Controlled Copy, Do Not Duplicate -- For Internal Use Only.

PT. SCG LIGHTWEIGHT CONCRETE INDONESIA

FORMULIR PENGISIAN DATA PELAMAR

APPLICATION FORM
3. FORMAL EDUCATION/ Pendidikan Formal

SD 02 Watesalit Batang

Year
Graduat
Start
e
2000
2005

Junior High School

SMP 07 Batang

2005

2008

Senior High School

MAN 03 Pekalongan

2008

2011

IPA

Universitas Diponegoro Semarang

2011

2016

Electrical Engineering

Education Level

Name and the place of the school

Elementary

Major

Academy
University
Post Graduate
4. INFORMAL EDUCATION/ Pendidikan Informal
Year
Course / Workshop / Seminar

Start

Asia-Pasifik
Seminar nuklir nasional UNDIP Teknik Lingkungan

2016
2013

Graduat
e
2016
2013

Information
English Conversation
Nuklir information

5. WORKING EXPERIENCE/ Pengalaman Kerja

Name of the company
PT PLN UDIKLAT

Position

Time of work (year)

from
2014

Freelance

until
2015

Last Salary Review

2.000.000

Reason for Leaving

looking for new
experiences

6. ORGANIZATIONAL EXPERIENCE/ Pengalaman Organisasi

Organization Name
1. PSMT UNDIP
2.

Type of Organization
(Student / Politic / Professional)
Student

Position
member

3.
7. LANGUAGE SKILL/ Kemampuan Bahasa
Language

Reading

1. English

fair

2. Jepang

beginner

Writting
fair
beginner

Speaking
fair
beginner

3.

Page 2 of 4
Controlled Copy, Do Not Duplicate -- For Internal Use Only.

PT. SCG LIGHTWEIGHT CONCRETE INDONESIA

FORMULIR PENGISIAN DATA PELAMAR

APPLICATION FORM
8. HUSBAND / WIFE (Suami/ Istri)
Full Name

: ______________________________________________________________________________

Date of Birth

: _______________________________________Place ___________________________________

Last Education

: Senior High School / Academy / University / Master of Degree*) (striketrough the unnecessary)

Job

: ______________________________________________________________________________

9. CHILDREN/ Anak
NAME

PLACE AND DATE OF BIRTH

M/F

PLACE

DATE

1.
2.
3.
10. PARENTS/ Orang Tua
NAME

AGE

EDUCATION

JOB
PNS pensionary
PNS

EDUCATION

JOB

S1
S1

1.Syaifijin
2.Solekhah
11. SIBLING/ Saudara
NAME

AGE

1.
2.
3.
4.
1. Are you at the moment still working

: Yes / No *)

(strikethrough the unnecessary)

Where: ____________________

(Apakah anda masih bekerja?)

2. Remuneration package expected

: Rp.4.500.000_____________________________________________________

(Berapa Paket Gaji yang diharapkan?)

3. When you are available to work

: immediately

(Kapan Anda dapat mulai bekerja?)

4. Do you have relatives who works here

: Yes / No *)

(strikethrough the unnecessary) Name: ____________________

(Apakah Anda mempunyai keluarga yang bekerja disini?)

5. Have you ever got serious illness or take intensive care? If yes please mention the time and kind of illness):
NO
6. Have you ever got accident or surgeries? If yes, when have you had it? Is it effect to your health condition right now?
YA , Just graze
7. If you accepted by this company do you agree to out of Karawang assignment?
YA
Here with I declare that all the data I have written above is true and accurate, if the data proved not true or fake, can cause my
application to be rejected or if I have worked can be terminated right away.
Conclusion:
1.
Processed
Semarang, 02 September 2016_________
2. Not Processed
Comments and reason:
_____________________________________________________

__________________________________

_____________________________________________________

Date, _______________________________________________
Page 3 of 4
Controlled Copy, Do Not Duplicate -- For Internal Use Only.

PT. SCG LIGHTWEIGHT CONCRETE INDONESIA

FORMULIR PENGISIAN DATA PELAMAR

APPLICATION FORM
FIRMAN EKA SAPUTRA

Page 4 of 4
Controlled Copy, Do Not Duplicate -- For Internal Use Only.