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APPLICANT DATA FORM

IDENTITY
KTP No. : SIM No.
Fullname :
Nickname : Sex : M/ F
Twitter account : __________________________________________________Facebook account: _____________________
Active email address : __________________________________________________
Address :
Address as in KTP :
Phone : Mobile phone:
House's owner status : Parents Own Rent/Lease
Place and Date of Birth :
Religion :
Marital Status : Single / Married / Widowed Nationality

MEDICAL CONDITION
Blood Type : Allergy
Accident experienced : Smoking : Yes / No
Ongoing health treatment :

FORMAL & INFORMAL EDUCATION

School Year
Degree Name of School Address Major Result
From To
Primary School
Junior High School
Senior High School
Academy
University
Others

Why did you choose that major in education?

Write the title of your final thesis to obtain your degree.

SPECIAL ABILITY
Foreign Language that are Mastered Oral Written Ability / Skills that are mastered (sports/arts/etc) Info

PARENTS & HUSBAND/WIFE'S DATA

Phone
Relation Name DoB Education Address Name of office Address of office Job
Number
Father
Mother
Father in law
Mother in law
Husband/Wife

SIBLINGS' Data
Phone
Relation Name DoB Education Address Name of office Address of office Job
Number
Brother/ Sister
Brother/ Sister
Brother/ Sister
Brother/ Sister

CHILDREN'S DATA
Date of Level/
Name Address Name of School Address of School
Birth Class

NEXT OF KIN
Date of Level/
Name Address Name of School Address of School
Birth Class

WORK EXPERIENCES IN THE LAST 10 YEARS

Job length Name and Address Job Description
Phone Job/Division References
Since To of prior workplace
Why did you leave your last job?

Why do you apply for this job in CIKAL?

Briefly tell us what do you know about this job.

How much salary do you get in the last job?

If there's any, what kind of allowance do you get?

How much salary do you hope will you get from CIKAL? (must be filled)

What kind of allowance do you hope you get from CIKAL?

PERSONALITY
How do you solve a problem and who do you ask for opinion when you meet a problem in your job?

What kind of problems that you often face in your previous job? How do you solve it?

Do you like working with children? Yes No Are you keen in interacting with children? Yes No
If the answer is yes, in what condition do you interact with children?

What kind of problems that you usually face in interacting with children?

Do you have strategy in facing children?

OTHERS
Tell us your hobbies or the things you do in your spare time?

Do you like travelling? Yes No

If the answers is yes, tell all the cities that you've visited (domestic and foreign)

Do you like to read? Yes / No Yes No

If the answer is yes, what kind of books do you like to read :
Tell the last book titles and the authors you had read or, the one you're reading right now.

Have you ever been in an organization? Yes No

If the answer is yes, tell us when, name of organization, job and division in that organization.

What do you know about CIKAL and where did you get the information from?

What do you think about child and family education?

The one who signed below tells that all the information that have been written above is true.
Jakarta, _________________________

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