APPLICATION FORM Confidential

Application Date : Position Applied :

Tanggal Aplikasi Posisi Yang Dilamar

Personal Data (Data Pribadi)

Full Name : Nationality :
Nama Lengkap Warga Negara
Nick Name : Male Female Blood Type :
Nama Panggilan Golongan Darah
Date of Birth :
Tanggal Lahir Weight : Kg. Height : Cm.
Berat Badan Tinggi Badan
Place of Birth : Marital Status :
Tempat Lahir Status Perkawinan
Country of Birth : Single Married Divorced Widowed
Negara Kelahiran
Religion : Tax ID :
Agama No NPWP
Province Origin : Jamsostek ID :
Asal Daerah No Jamsostek
Ethnic Origin : Hobby :
Suku Hobi

Address (Alamat)
Permanent Address (according to ID Card) Current Address (according to ID Card)
Alamat tetap (sesuai KTP) Alamat sekarang
Street/House No : Street/House No
Jalan/Nomor Rumah Jalan/Nomor Rumah

City / Province : City / Province :

Kota/Propinsi Kota/Propinsi
Postal Code : Postal Code :
Kode Pos Kode Pos
Telephone / Hp : Telephone / Hp :
No. Telepone No. Telepone
Email : Email :
Surat Elektronik Surat Elektronik

ID Data (Data Identitas)

ID Type Driving License Type :
KTP A B1
Jenis ID Jenis SIM
Passport B2 C
ID No : Driving License no :
Nomor ID No. SIM
Country of Issued : Date of Issued :
Dikeluarkan di Negara Tanggal Dikeluarkan
Date of Issued : Valid to :
Tanggal dikeluarkan Berlaku Sampai
Valid to :
Berlaku sampai

Language (Kemampuan Bahasa)

Language Coversation Written Reading
Basic Intermediate Fluent Basic Intermediate Fluent Basic Intermediate Fluent
Indonesia
English
Other

Formal Education (Pendidikan Formal)

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 APPLICATION FORM Confidential
Level of School* Graduation Name of Institute City Major GPA
Tingkatan Sekolah Year Nama Institusi Kota Jurusan IPK
Tahun Lulus

*Level : Elementary School / Junior High School / Senior High School / Diploma / Bachelor / Master

Informal Education (Pendidikan non Formal) / Training

Course Name Institute / Location Start / Finish Date (dd/mm/yy)
Nama Pelatihan Penyelenggara / Lokasi Mulai / Sampai (hh/bb/tt)

Dependents Data (Data Tanggungan)

Relationship Full Name Date of Birth Gender Occupation
Hubungan Nama Lengkap Tanggal Lahir Jenis Kelamin Pekerjaan
Spouse :
Pasangan
Child 1 :
Anak 1
Child 2 :
Anak 2
Child 3 :
Anak 3
Name of Birth
Mother :
Nama Ibu Kandung

Emergency Contact (Kontak Darurat)

1 2
Name :
Nama
Relationship :
Hubungan
Address :
Alamat

Phone / Mobile No :
Nomor Telepon

Bank Detail (Detail Bank)

Bank Name :
Nama Bank
Account No
Nomor Rekening
Beneficiary Name :
Nama Pemilik Rekening
SWIFT Code No :

Address / Branch
Alamat / Cabang

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 APPLICATION FORM Confidential
Previous Employer (Riwayat Pekerjaan)
Give chronological order beginning with most recent position. Please complete even if you've submitted a resume (berikan urutan
berdasarkan posisi terbaru. Lengkapi meskipun anda sudah mengirimkan resume)
Company Name :
Nama Perusahaan
From / To (dd/mm/yy)
Mulai / Sampai (hh/bb/tt)
Business Nature :
Jenis Usaha
Current or Last Position :
Posisi Sekarang atau Terakhir
City / Country :
Kota / Negara
Starting Base Salary :
Gaji Pokok Awal
Present or Ending Base Salary :
Gaji Pokok Sekarang atau Terakhir
Date of Last Salary Increase :
Tanggal Kenaikan Gaji Terakhir
Type, Amount and Frequency of Other
Compensation (E.G., Commissions,
Bonus, Profit Sharing, Etc)
Reason of Leaving :
Alasan Berhenti
Please describe in detail the task (Jelaskan secara rinci tugas anda)

Company Name :
Nama Perusahaan
From / To (dd/mm/yy)
Mulai / Sampai (hh/bb/tt)
Business Nature :
Jenis Usaha
Current or Last Position :
Posisi Sekarang atau Terakhir
City / Country :
Kota / Negara
Starting Base Salary :
Gaji Pokok Awal
Present or Ending Base Salary :
Gaji Pokok Sekarang atau Terakhir
Date of Last Salary Increase :
Tanggal Kenaikan Gaji Terakhir
Type, Amount and Frequency of Other
Compensation (E.G., Commissions,
Bonus, Profit Sharing, Etc)
Reason of Leaving :
Alasan Berhenti

Please describe in detail the task (Jelaskan secara rinci tugas anda)

Company Name :
Nama Perusahaan

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 APPLICATION FORM Confidential
From / To (dd/mm/yy)
Mulai / Sampai (hh/bb/tt)
Business Nature :
Jenis Usaha
Current or Last Position :
Posisi Sekarang atau Terakhir
City / Country :
Kota / Negara
Starting Base Salary :
Gaji Pokok Awal
Present or Ending Base Salary :
Gaji Pokok Sekarang atau Terakhir
Date of Last Salary Increase :
Tanggal Kenaikan Gaji Terakhir
Type, Amount and Frequency of Other
Compensation (E.G., Commissions,
Bonus, Profit Sharing, Etc)
Reason of Leaving :
Alasan Berhenti
Please describe in detail the task (Jelaskan secara rinci tugas anda)

Activity & Organization (Aktivitas dan Organisasi)

Name of Organization Organization Type Position Year
Nama Organisasi Jenis Organisasi Posisi Tahun

Others (Lain-lain)
What do you know about our company ?
Apa yang anda ketahui dari perusahaan kami?

What are your expectation from our company if you are employed ?
Apa yang anda harapkan dari perusahaan kami jika diterima bekerja?

Do you have any relatives who are currently working for our company ?
Apakah anda mempunyai anggota keluarga/saudara yang bekerja diperusahaan kami?

Have you ever suffered from a serious illness ?

Apakah anda pernah menderita penyakit yang serius?

Do you have a part-time job right now ?

Apakah anda mempunya pekerjaan sampingan saat ini?

Are you willing to travel ?

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 APPLICATION FORM Confidential
Apakah anda bersedia melakukan perjalanan dinas?
Yes No

Are you willing to be relocated ?

Apakah anda bersedia direlokasikan?
Yes No
If Yes, please write your location preference :
Jika ya, silahkan tulis lokasi yang anda inginkan
Expected Salary : Notice Period : Available Date :
Gaji yang diharapkan Masa Pemberitahuan Tgl. Mulai Bekerja

I certify that answers given herein are true and complete to the best of my knowledge. I authorize you to make such investigations and
inquire of my personal, employment, financial or medical history and other related matters as may be necessary in arriving at an
employment decision. I hereby release employers, schools or persons from all liability in responding to inquires in connection with my
application. In that event of employment, I understand that false or misleading information given in my application or interview (s)
may result in discharge, I understand also that I am required to abide all rules and regulations of the Company.While other terms of my
employment may change from time to time, I understand that the at-will nature of the employment relationship can only be changed by
a written agreement signed by the Human Resources Director and by Me.

Date Applicants Signature

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