G4S INDONESIA

FORMULIR LAMARAN KERJA

APPLICATION FORM C S
S S
Melamar Posisi : HSE Manager
Position applied for

Identitas Diri
Personal Information

Nama Sesuai KTP : Yudha Pranata

Full Name based ID

Nama Panggilan : Yudha

Nick Name

Tempat/Tgl. Lahir : Subang / 14 Oktober 1983

Place/Date of Birth
Jl. Rengas No.25 RT.05 RW.06 Pondok Labu.
Alamat : Jakarta Selatan. 12450
Address

No. Telepon Rumah : (021) 7502384 No. Telepon Kantor : (021) 7506750
Home Phone No. Office Phone No.

No. Telepon Selular : 082122041879 Status Perkawinan : Married

Mobile Phone No. Marital Status

Jenis Kelamin : Male Agama : Islam

Gender Religion
yudhapranata69@gmail.co 321303141083000
Alamat Email : m No. KTP : 7
Email Address ID Card No

SIM C/A/B1/B2 : A
No. SIM : 83101205971801
SIM Card No

Keluarga Nama Usia Pendidikan Pekerjaan Nama Perusahaan

Family Name Age Education Job Name of company

Ayah Mochamad Yaya 59 S1 Pensiun PTPN VIII Subang

Father Jatnika
Ibu Ibu Rumah
Farida Andriani 57 SMU -
Mother Tangga
Suami/Istri Amalia Idaman 35 S1 Profesi Dentist Eka Hospital BSD
Spouse Sehan Putri
Anak 1 Indira Jehan 5 K1 Student -
Child 1 Maheshvari
Anak 2
Child 2

Anak 3
Child 3

Tahun Pendidikan
Pendidikan Terakhir Nama Sekolah Dan Universitas Jurusan Year of education
Last Formal Education School AndUniversity’s Name Major in
Dari / From Sampai / To
Pasca Sarjana
Post Graduate

Appform rev 0219/G4S/HR

Diploma/Sarjana Agriculture
Universitas Padjadjaran 2001 2007
Diploma/Bachelor Engineering
SMA
High School SMUN 1 Subang IPA 1998 2001

Pendiddikan Non Formal / Kursus / Training Bulan / Tahun Keterangan

Non Formal Education / Courses / Training Month / Year Remarks
1. Ahli K3 Umum 05/2014 Certified
2. Contractor Safety Management System 05/2018 Certified
3. ISO intergrated Management System 03/2017 Certified
Tingkat Keahlian
Bahasa Baik / Cukup/ Kurang Catatan
Language Skills Skill Level Remark
Good / Fair / Poor
1. Indonesia Good
2. Inggris Fair
Tingkat Keahlian
Komputer Program Baik / Cukup/ Kurang Catatan
Computer Program Skill Level Remarks
Good / Fair / Poor
1 Microsoft Office Good
2 Adobe Photoshop Fair

Riwayat Pekerjaan 5 tahun terakhir

Employment history for the last five years
Tahun Nama Perusahaan Jabatan Atasan Langsung Gaji Pokok Alasan Keluar
Year Name of Company Job Title Direct Superior Salary Reason for Leaving
2016
PT.
- HSE Deputy GM- 1669000
1. Metropolitan
curre Manager HR 0
Kentjana Tbk
nt
2014 HSE
PT. Andalan Factory 1080000
2. - Dept Got better offering
Furnindo Manager 0
2015 Head
2012 HSE
PT. Mutiara Chief Site 1380000
3. - Coordina Location
Bara Energy Officer 0
2014 tor
2007
PT. Rukun HSE HSE Dept
4. - 8000000 Got better offering
Makmur Officer Head
2012

5.

Referensi (Kepada siapa kami dapat menanyakan tentang kinerja kerja Anda, selain saudara Anda)
Reference (List of reference who know your professional performance, not your family)

Hubungan Nama Alamat & Telepon Keterangan

Relation Name Address & Phone Remarks
Jakarta HSE
1 Rekan Kerja 1 Adhiyasa Nugraha (082125907320 Supervisor
) (PT.

Appform rev 0219/G4S/HR

 Metropolitan
Kentjana)
Jakarta (021-
2 HR Manager 2 Emir Faisal Rahman HR Manager
7506750)

Jakarta (021- General

3 Atasan Langsung 3 Eka Dewanto
7506750) Manager

KETERANGAN TAMBAHAN
Additional Information

Apakah Anda mempunyai saudara yang bekerja di perusahaan ini?

Sebutkan nama dan hubungan Anda
Do you have family who is working in this company? No
Please mention his/her name and your relationship with him/her

Bila diterima, berapa gaji dan fasilitas apa yang diharapkan? 25000000 ; Medical &
What is your expected salary and benefits? Transportation
Bila diterima, kapan Anda dapat mulai bekerja?
When will you be ready to join? September 2019

(khusus pelamar security officer)

Apakah anda memiliki sertifikat training security (Gada Pratama, Gada
Madya, Gada Utama) ?
Bila memiliki mohon disebutkan
(only security officer applicant)
Do you have Security Certification (Gada Pratama, Gada Madya, Gada Utama)?
If yes, please specify

Apakah Anda pernah terlibat dalam tindakan kriminal atau dijatuhi

hukuman oleh pengadilan karena tindakan kriminal?
Ya (Yes) Tidak(No)
Have you been involved in any criminal activities or being sentenced by the
court for any criminal cases ?

Apakah Anda bersedia untuk dilakukan Reference Check ke perusahaan

tempat Anda bekerja sebelumnya? Ya (Yes) Tidak(No)
Do you mind if we do reference check to you previous company?

BACALAH PERNYATAAN INI DENGAN TELITI

PLEASE READ THIS STATEMENT CAREFULY

Saya menyatakan bahwa informasi yang saya berikan pada formulir ini benar, lengkap dan akurat. Saya mengerti
jika terdapat pemalsuan atau pengurangan informasi dapat mengakibatkan pemutusan hubungan kerja.

I hereby affirm that the information given by me on this application for employment is true, complete, and accurate. I understand
that Any falsification or omission will be considered sufficient cause for dismissal.

Saya bersedia untuk dilakukan pemeriksaan latar belakang (background check/vetting) dan bersedia mengikuti
proses seleksi rekrutmen sesuai ketentuan perusahaan. Saya memahami bahwa proses rekrutmen ini mensyaratkan
kelengkapan dan kesesuaian dari hasil pemeriksaan.

I agree to be checked my background (background check/vetting) and also willing to follow whole selection and recruitment
process based on company regulation. I understood that the recruitment process is subject to the completion of initial screening
and vetting which is satisfactory to G4S.

Appform rev 0219/G4S/HR

Dan saat ini saya dalam keadaan sehat jasmani dan rohani.

And I declare that I am currently in good health both physically and psychologically.

Tgl/Bln/Th
Date/Month/Year

Pelamar / Applicant

Appform rev 0219/G4S/HR