No:

APPLICATION FORM Date:

Applied Division : Employment Status :

Assurance Tax TAS Advisory CBS - Support Permanent Internship

Applied Position : Transaction Advisory Service Senior Consultant When can you start? 15/07/2019

Full Name

(based on ID card/KTP) (First Name) (Middle Name) (Last Name)

Current Address Jl. Tawakal IV A No.14B, Tomang, Grogol Petamburan

City West Jakarta Postal Code 11440 Country Indonesia

Contact Mobile phone 081517144433 Home

Email Address ugasiregar@gmail.com Office

Where do you live ? own house rented house boarding house with parents others

Permanent Address Jl. Jatiluhur Raya, Blok.DU 12 No.5

(based on ID Card / KTP / Passport)

City Bekasi Postal Code 17145 Country Indonesia

Identification Card No. (KTP/Passport*) 1277012411920

*) applied for expatriate employee

Sex (M / F) M Age 27 years old

Date of Birth 24/11/1992 Place of Birth Padangsidimpuan

Citizenship Indonesia Religion Moslem

Civil Status : Single Married Widowed Separated

No. of Children No. of Dependents

EDUCATION RECORD :
Major
Inclusive Date Course Honors/
Education Name of School City Degree GPA Certificate No.
From To or Subject Rank
Senior High School SMA Negeri 4 Padangsidimpua 2007 2010
(SMU)
Academy

University Trisakti University West Jakarta 2010 2014 Bachelor Accounting 3.10 0591/FE/S1/AK/
X/2014

Postgraduate / Advance StudiesTrisakti University West Jakarta 2019 Now Postgrad Management
uate

Others Courses Trisakti University West Jakarta PPAk

Computer skills Microsoft Excel, Word, Power Point, MFAPPL, Confins, ACA

pHOTO Ph
English skills Low Medium Good Excellent

Other language

Low Medium Good Excellent

Photo
Where did you hear EY Career Website EY Campus Hiring
about our job
vacancy? Application ID Location

Job Advertisement Others

If so, please specify If so, please specify

Application Form - EY Recruitment - 04/16

 Linkedin

Application Form - EY Recruitment - 04/16

PROFESIONAL MEMBERSHIP QUALIFICATION (CPA, CIA, CISA, Brevet etc.)

Title of Certificate Name Professional Association/Organization No of Certificate Issued by (City, Country) Dates/Year Certification

RECORD OF EMPLOYMENT

Present Employer Past Employer 1 Past Employer 2 Past Employer 3

Company Name PT, Dipo Star Finance

Subsidiary Mitsubishi KAP Djoko Sidik Indra

Address Sentral Senayan 2, 3rd

floor, Jl. Asia Afrika No.8 Graha Mandiri 19th floor, Jl. Imam
Senayan Jakarta Bonjol No. 61, Central Jakarta

Nature of Business
Financing Audit, Tax, Business Consultantts

Your position/title Senior Associates Internal

Auditor Auditor
Period of Employment
(Start - End) 2016 - Now 2015 - 2016
Starting monthly
Salary (gross) 6000000 3000000
Present salary/ salary
Upon leaving (gross) 8500000 3000000
I want to face more
Reason for challenge and I need new In order to enhance my skill set, I
experiences for the sake of am looking for better
Leaving my future. opportunities

Have you ever been dissmissed or suspended by your previous employersNever If so, state date

by which company and the case

FAMILY BACKGROUND:
Give names and addresses of your family background
Occupation and
Name Address / Telephone
Employer
Father Ahmad Buchori Siregar 082294833257 Civil Servant
Mother Maulina Sari Lubis 082168869878 Entrepreneur
Aidina Rizki Machari Siregar 081397963112 Entrepreneur
Siblings Indah Awan Hanifah 085275564596 Doctor
Abbas Pahlawan Siregar 081289214709 Student
Spouse

Child

REFERENCES:
Give names and addresses of person/ contact number, preferably those in business or profession, who have known you for at least three years.
(Do not give names of relatives)
Number of
Occupation and
Name Address / Telephone Email Years of
Employer
Acquaintance
Fauzan Jl. Permata, Grogol / 085375577777 fauzan@dipostar.com Internal auditor 7

Are you related to any partner or employee of this Firm ? No, I am not if so, to whom?

Name referral in our employ

Were you involved in any administrative, civil or criminal case? No, I wasn't if so, please specify

Have you taken our entrance test before? Yes, I have If so, when 2014 date/year

Minimum monthly salary acceptable (Gross) Rp. 10,000,000

Application Form - EY Recruitment - 04/16

Explain briefly below your reason (s) for applying with us and state why you believe you are qualified for the position:
I have very good administrative skills that I believe are very necessary in this company. Besides that, I also really enjoy working with many people which is certainly needed in
this position and I have good intelligence, experience and communication skills so I want to be an asset to this company. I believe I’m the one to fill the position because I’m
experienced and I personally have my own passion in this field. I’m sure I can give my best to this position if I’m chosen

I certify that the printed information on this form or any supplements, and supported documents to support this form is complete and accurate.

I hereby authorize EY entities to perform employment reference checks on my previous employment, verify academic checking, and conduct full background
checks including personal references. This is not limited to overseas inquiries if necessary and, I authorize to release my personal data outside of Indonesia in
the course of processing.

I consent to release my personal data to a third parties for background check purpose. I also consent the recipients of such enquiries to provide the data requested.

I understand that my offer is that I may withhold my permission and that in such a case, no investigation will be done and my application for employment will
not be processed further.

____________________________________
Signature

____________________________________
Name                                                         

____________________________________
Date

Application Form - EY Recruitment - 04/16

 Certification Provider
Ikatan Akuntan Indonesia (IAI) CA
Ikatan Akuntan Publik Indonesia (IAPI) CPA
Association of Certified Fraud Examiners (ACFE) CFE
EC - Council CEH
EC - Council CHFI
Information System Audit Consultant Association (ISACA) CISA
Ikatan Konsultan Pajak Indonesia (IKPI) CISM
CFA Institute CGEIT
CRISC
Brevet A
Brevet B
Brevet C
CFA
 Certification
Chartered Accountant (CA)
Certified Public Accountant (CPA)
Certified Fraud Examiners (CFE)
Certified Ethical Hacker training + Certification (CEH)
Computer Hacking Forensic Investigation training + Certification (CHFI)
Certified Information System Auditor (CISA)
Certified Information SecurityManager (CISM)
Certified in the Governance of Enterprise IT (CGEIT)
Certified in Risk and Information Systems Control ( CRISC)
Ujian Sertifikasi Konsultan Pajak (USKP)Tingkat A
Ujian Sertifikasi Konsultan Pajak (USKP)Tingkat B
Ujian Sertifikasi Konsultan Pajak (USKP)Tingkat C
Chartered Financial Analyst (CFA)