BAY EEO [EMPLOYMENT APPLICATION FORM ‘Yang bertandatangan dibanah ini Post applied for Bacalsh dengan tel dan islah semua pertanyaan dbawat ini dengan tusantengan seni (Pease read careuly, then answer al the follwing questions in your own handing) Penerimaan formuli ini bukan jaminan penerimaan anda Sabogal karyawan melainkan ‘merupakan bahan perimbanangan seperlunya, Jka tercapat lonongan yang cocok dan lemaran anda dsetujl, maka anda harus dnyatakan sehat melalui pemercsaan dokter ‘dan juga harus melampirkan Surat Keterangan Kelakuan Baik dari Kepolsan (he acceptance ths plication affords no assurance of eventual employment but ‘tl receive careful consideration. IF any sutable vacancy exis or cers and your application is approved It wil be necessery fr you to pass medical examination by 1 physicion and reference letter from Potce) Photo agen IDENTITAS PRIBADL (Persone Pakuers) Nama name ‘Amat sementare Teepon Temporary adress Prone / Ho ‘Alama tap Telepon Permanent actress Prone / Ho “Tanggal ahr Tempat lair Tenis telamin [Mit] FIP Date of bith ‘Alce of bith Sex erat badan Tinggi Badan Kelanan sk, jk ada ‘Golongan dara Weight Pei Physical mpaioment, Fany Type of bod | *0 on alas sfo Kabangsoon Satusperkaninan | Sige | Mares [Widower] Agam= ‘Natonalty Mant status Reign Name keluarga dekat ‘Namat Te ‘ame of relative Aires Toe Nama yang ékenggung | eriskelomin | Tanggaliahir_| endian Pekeriaan Hubungan Ker ‘Name of dependent = ate of rh | Education (Occupation Relate fh wae _| Female b. ale | Female b. Male | Female ke ale | Female Nama keuarge | Umur Pendikan ekeroan ‘mat Family name Age oveaton ‘Gecepation Ares ‘nah Father bu /Motier[, RIWAYAT PENDIDIKAN (History of Education) Page : 2066 Nama Sekolah Sonisan Tahun / Year Berazah ame of schoo! ajoring Dan Fam | Sameai/ To Passed 1. fo 2, [sue 3. [sua 4, [Akademi 5. [Universitas [so (sa Pudul skips tugas alte Tile IIL, RIWAYAT PEKERIAAN Mai pekerjan terak, termasuk Dinas Mer jka aca (History of employment) Sart ith last or present and include Miltary Senice any Perusahean Tanggal/ Date Tabatan terakhir | _ Gai terakhir “asan Kear Gompany Dari/ From [Sampai/ To | lastpastion | tase sary Reason of eaving 1 2, 3 a 5. 6. 7. IV, RIWAYAT TRAINING / KURSUS (History of Training / Course) Jens tairing | aes Tahun Hasi/ Nisi_| _ bissenggarakan leh Type of traning / course Year Rest Conccted by 1 2, 3 a 5 6. 7. . KEMAMPUAN BAHASA DAN KONPUTER Bahasa yang dks Merb enuls Barbie Keterangan Language mastery Read wre ‘Seok Remark 1. [Bahasa ingros/ Engin Penguasen Komputer Bak Coke Karena) Keerangan Computer abity Good Far Poor | ‘Remark [Soread sheet (Lotus, excel) [word processor (WS,MS Word etc) Daa base (chase, oper sc) Lain otherPage: 3 0f6 Isiah menurut pendapat anda sendir / Please fin according to your gonion (sefrating) emampuan Teknik Classification emampuan acministasi cassifeation Technical sil ale[clole Administration sil alte[c[ole i Mechanical 1 Accounting 2 construction equipment 2 Personnel Administration 3._Bectrical Instrument 3._ Operation Computer “4. Fabrication 4 Secretarial 5._enginesring 5._Englsh Language: Special Technic Finance 7. Logistic 7._Avaiting Sil &_Qualty Control 8._Project Contrl Eng. Skil 3. Chilengineering 9, Project management 10. Quality Management System “11,_HSE Management System Note: ‘A= Dapat menganas! dan melatin orang lain / Able to tran and supervise other pegole B= Dapat mengerjakan, dapat melatih dan menjamin kualtas / Able todo, to rain and to assure the qualty Dapat mengerjakan keterampilan dengan baiktetapi tidak dapat mengawasi/ Able f0.do the ski good but not syperising Teelatin ttapi tidak cipraktekan secara teratur / Trained but not regular practice E= Memeriukan training segera untuk jabatan & tugas sekarang / Need training for present duties VI URAIAN PRIBADE (Set description) |. Mengapa anda tertarik untuk bekerja di perusahaan il ? Wihy ae you interested in working our cornpany ? 2. Apalch anda mau bekerja clapangan ? Ber alasan ! ‘Are you agree with assionnent to work at job site ? Give your reason ! 3. Apakh anda mempunyaiteman atau saudara diperusahaan in, kalau ada tulis nama dan hubungannys apa? ‘ave you any fiend / relation working in tis company?. If any, state the name and Kin of relationship 4. Apakah yang menjadi dasar dari motvas /gerak utama anda dalam bekeria Wihat is your main source af motivation in your werking ? 5. Apakah keinginan anda dalam bekerja ?/ What are your interest in your norking ? 16. Apakah anda sebelumnya melamar pada PT Koin Pratama ? ka ya, kapan ? Have you previously applied to this company ?If yes; When ? 7. No. KT/SIN/ASTEK (No ID/SIMYASTEK :