EMPLOYMENT APPLICATION Photograph

LAMARAN PEKERJAAN 3X4

Position Applied For 1. Pasfoto

3x4
Posisi yang dikehendaki 2.

Salary Expected/ Gaji yang diinginkan

Commencement Date/ Tanggal bergabung

PERSONAL DATA/ DATA PRIBADI

Full Name/ Nama Lengkap :
Nick Name/ Nama Panggilan :
I.D/Passport No./Nomor KTP/Paspor :
Date Of Birth/ Tanggal Lahir :
Place Of Birth/ Tanggal Lahir :
Religion/ Agama :
Nationality/ Kebangsaan :

Home Address/ Alamat Rumah :

Bandung Address/ Alamat di Bandung :

Mobile Phone No./ No. Telepon Selular :

Email Address/ Alamat Email :
Hobbies/ Kegemaran :

IN CASE OF EMERGENCY, WHOM SHALL WE NOTIFY?/ DALAM KEADAAN DARURAT, SIAPA YANG BISA KAMI HUBUNGI?

Name/ Nama :
Relationship/ Hubungan :
Address/ Alamat :
Telephone No./ Nomor Telepon :

Marital Status/ Status Perkawinan

Single/ Belum Menikah Married/ Menikah
Seperated/ Berpisah Divorced/ Bercerai

If Married State/ Jika Sudah Menikah

Name Of Spouse/ Nama Pasangan Hidup :
Occupation/ Pekerjaan :
Children/ Jumlah anak :

FAMILY RECORD/ DATA KELUARGA

List Name Of Natural father, mother, brother, and sister only/ Tuliskan nama ayah, ibu, saudara laki-laki dan saudara perempuan kandung
If married list names of natural children/ Jika sudah menikah tuliskan nama anak kandung
Relationship Age/ Usia
Name/ Nama Address/ Alamat Occupation/ Pekerjaan
Hubungan

All applications will be treated in confidence

EMPLOYMENT RECORD/ SEJARAH PEKERJAAN
Start with your present position and work back/ Diawali dengan posisi dan pekerjaan terakhir
I Company or Firm/ Perusahaan
Address/ Alamat :

Telephone No./ Nomor Telepon

Nature Of Business/ Jenis Perusahaan : Name of Supervisor/ Nama Atasan Langsung: Monthly Salary/ Gaji Perbulan:

Nature Of Your Work/ Jenis Pekerjaan: From/ Dari : To/ Sampai :

Reason for Leaving/ Alasan kenapa berhenti :

II Company or Firm/ Perusahaan

Address/ Alamat :

Telephone No./ Nomor Telepon

Nature Of Business/ Jenis Perusahaan : Name of Supervisor/ Nama Atasan Langsung: Monthly Salary/ Gaji Perbulan:

Nature Of Your Work/ Jenis Pekerjaan: From/ Dari : To/ Sampai :

Reason for Leaving/ Alasan kenapa berhenti :

III Company or Firm/ Perusahaan

Address/ Alamat :

Telephone No./ Nomor Telepon

Nature Of Business/ Jenis Perusahaan : Name of Supervisor/ Nama Atasan Langsung: Monthly Salary/ Gaji Perbulan:

Nature Of Your Work/ Jenis Pekerjaan: From/ Dari : To/ Sampai :

Reason for Leaving/ Alasan kenapa berhenti :

IV Company or Firm/ Perusahaan

Address/ Alamat :

Telephone No./ Nomor Telepon

Nature Of Business/ Jenis Perusahaan : Name of Supervisor/ Nama Atasan Langsung: Monthly Salary/ Gaji Perbulan:

Nature Of Your Work/ Jenis Pekerjaan: From/ Dari : To/ Sampai :

Reason for Leaving/ Alasan kenapa berhenti :

All applications will be treated in confidence
EDUCATION/ PENDIDIKAN Name and Address of School Peiod/ Certificate Obtained/
Nama dan Alamat Sekolah Periode Berijasah

Professional Training/ Pelatihan Profesional

University/ Universitas

Senior High School/ Sekolah Menengah Atas

Junior High School/ Sekolah Menengah Pertama

Elementary/ Sekolah Dasar

SKILL/ KEAHLIAN
Special Skill/ Keahlian Khusus:

OTHER LANGUAGE/ BAHASA ASING

Name Of Languange/ Spoken/ Lisan Written/ Tulisan Understanding/ Pengertian

Excel/ Good/ Fair/ Excel/ Good/ Fair/ Excel/ Good/ Fair/

Jenis Bahasa
Sangat Baik Baik Cukup Sangat Baik Baik Cukup Sangat Baik Baik Cukup

ORGANIZATION/ Organisasi
State name of club, Society or Organization that you are member of, or were a past member of/
Sebutkan nama klub, Perkumpulan atau Organisasi dimana Anda masih atau pernah menjadi anggota.

Organization/ Organisasi Nature of Organization/ Jenis Organisasi Membership/ Status Keanggotaan

HEALTH STATUS/ KESEHATAN

Do you have now or ever had any of the following ailments? If Yes
Apakah anda sekarang sedang atau pernah mengidap salah satu Jika YA

Heart Trouble/ Penyakit Jantung High Blood Pressure/ Tekanan Darah Tinggi
Asthma/ Asma Nervous Disorder/ Gangguan Saraf
Skin Problem/ Masalah Kulit Drug Addiction/ Ketergantungan Obat
Diabetes/ Kencing Manis Back Injury/ Cidera Punggung

Have you any handicaps in the following ? If YES

Apakah anda memiliki cacat sebagai berikut ? Jika YA

Speech/ Bicara Head/ Kepala Epylepsy/ Ayan

Hearing/ Pendengaran Sight/ Penglihatan

Blood Type/ Golongan Darah :

Have you ever had any an injury or operation ? YES/ Ya NO/ Tidak
Apakah anda pernah terluka atau operasi? Please Expalin/ Jabarkan
Do you have any other serious illness?
Apakah anda memiliki penyakit serius lain?

All Applications will be treated in confidence

CHARACTER REFERENCE/ REFERENSI

Relative (s) or friend (s), if any employed by Topotels Indonesia

Keluarga atau kawan yang bekerja di Topotels Indonesia

Name/ Nama Position/ Posisi Location/ Lokasi Relations/ Hubungan

List 3 or more persons, but exclude relative or former employer

Sebutkan 3 atau lebih, diluar saudara dan persahaan terdahulu

Telp No./ Occupation/ Length of Acquaintance/

Name/ Nama Address/ Alamat
Nomor Telepon Pekerjaan Lama Mengenai

YES NO If So, give particulars/

Mark with an "X"/ Berilah tanda "X"
YA TIDAK Jika ya, jelaskan

Have you ever been discharged from employment because of your work or conduct
was not satisfactory?
Apakah Anda pernah dikeluarkan dari pekerjaan anda karena prestasi anda yang

tidak memuaskan?

Did you receive any other income such as retirement pay, compensation for
injuries, etc?
Apakah Anda menerima pendapatan lain seperti pensiun, asuransi kecelakaan, dll?

Have you ever been charged in court?

Apakah Anda pernah dihukum?

May inquiry and reference check by made of your present regarding your qualifications
and character?
Apakah anda keberatan apabila kami bertanya tentang karakter dan kualifikasi anda

pada perusahaan anda sekarang?

Have you performed military service?

Apakah anda pernah dinas kemiliteran?

Have you ever been treated in s drug rehabilitation center?

Apakah anda pernah dirawat di pusat rehabilitasi?

DECLARATION/ PERNYATAAN
I authorize Topotels Indonesia to secure any information regarding myself
I further declare that the statement made by me in this application are true, complete and correct
A false statements or dishonest answer to any question may be grounds for my immediate discharge form employement with
Topotels Indonesia

Saya memberi kuasa kepada Topotels Indonesia untuk memeriksa mengenai kebenaran informasi yang saya buat

Saya menyatakan bahwa pernyataan yang saya buat adalah asli, lengkap dan benar

Pernyataan yang salah atau jawaban yang tidak jujur dapat menyebabkan saya kehilangan kesempatan untuk bekerja di Topotels Indonesia.

Date/ Tanggal Signature/ Tanda Tangan

All applications will be treated in confidence

 For Office Use Only For Office Use Only For Office Only
Code *) Code *) Code*)
General Environment Capability
General Appearance Courage & Conviction Dove for Results
Attitude Teamwork Understanding the Business/ Market
Eloquence Understanding People Problem Solving & Decision Making
Mental Alertness Working Within Organizations Customer Focus
Initiative Impact and Influence Strategic Thinking & Innovation
Job Knowledge Adaptability Building Capability
Language Leading & Developing People Leading to Win
Cultural Awareness Self Development
Implementation

*) 1 - Unacceptable 2 - Improvable 3 - On Target 4 - Commendable 5 - Superior

Accepted Rejected Filed for future vacancy

Result : Pending

If Accepted
To commence work on : Position :
Salary Offered :
Confirmation :

Remarks :

Date : Reviewers's Signature :

Date : Reviewers's Signature :

Date : Reviewers's Signature :

All Application will be treated confidence