APPLICATION FORM

POSITION CODE:
Full Name :
Place/Date of Birth :
Address :
Email :
Phone/ HP :

University Faculty/Major Year (From/To) Degree GPA

SMK/SMU
S1/D3
S2

Course/Training Address Course/Training Address

1. 3.
2. 4.

Organisation/Extracurricular Address Position Year (From/To)

Language Fluent Good Poor Language Fluent Good Poor

1. Indonesia 3.
2. English 4.
Internship/ Working Experience
1. Company Name Position Year (From/To) Salary Reason of Leaving

Describe your work responsibility

2. Company Name Position Year (From/To) Salary Reason of Leaving

Describe your work responsibility

3. Company Name Position Year (From/To) Salary Reason of Leaving

Describe your work responsibility

 Expected salary : Rp.

 Why do you want to apply for that position?
 Are you willing to be assigned outside Medan? Willing Not Willing
 Strength :
 Weakness :
,

I declare that all the information given is true. I am willing to withdraw from the
recruitment process if any of the statement is incorrect.