CONFIDENTIAL

PT PELAYARAN TEMPURAN EMAS Tbk

& Subsidiaries

EMPLOYMENT APPLICATION FORM

NAME : MOHAMMAD ILHAM UTAMA PHOTO

(ATTACH

APPLIED POSITION : SALES / MARKETING HERE)

FILL OUT THIS FORM WITH CAPITAL LETTERS

JOB VACANCY INFORMATION SOURCE

Career Day x Internet : …………………. Relation
Advertisement Friend Others ………………………….

PERSONAL INFORMATION
Full Name : MOHAMMAD ILHAM UTAMA X Male Female

Birthplace : JAKARTA 0 6 Date 1 1 Month 9 2 Year

Present Address : Citizenship : INDONESIA

JLN. KAYUMAS UTARA BLOK U/284A PULOGADUNG Home Phone :-

JAKARTA TIMUR Mobile Phone : +62 85782834147

City : JAKARTA ZIP : 13260 Email : m.ilham_tkd@ yahoo.com

F/HRD-R&S/02 rev.00 – [1]

 ID Card / Passport Number : Residence Ownership Status :
KTP 3175020611920005
Personal Family Rent Others ………………...
Driving License Number :
A 921112053445 x
x
Taxpayer Identification Number : x
…………………………………………...

Religion : MUSLIM

Blood Type : A B AB O Weight : 80 kg Height : 176 cm

X

Parents / Family Address : Citizenship : INDONESIA

JLN. KAYUMAS UTARA BLOK U/284A PULOGADUNG Home Phone :-

.
JAKARTA TIMUR Mobile Phone : +62 81347240004

City : JAKARTA ZIP : 13260

Own a Vehicle : Yes X No Vehicle Ownership Status:

Personal Family Company Others ………………

Type / Model : HONDA Year : 2016 X
BRV

FAMILY
Marriage Status X Single Married Others ………………………………….

Relationship Name Date of Birth Latest Education Occupation

Father GUSTIAN SAMURA 10-08-1965 MAGISTER EMPLOYEE

MANAGEMENT (S2)
Mother ERWINA DWI RAHAYU 26-02-1969 SENIOR HIGH HOUSE WIFE
SCHOOL
Siblings 1. MOHAMMAD ILHAM 06-11-1992 BACHELOR CUSTOMER
UTAMA (CANDIDATE) RELATION
(include yourself) 2. MUHAMMAD AKBAR 07-10-1995 UNIVERSITY -
DWIPUTRA STUDENT

3. PUTI NADHIRA AZALIA 07-06-2000 JUNIOR HIGH -

SCHOOL
4. -

5. -

Spouse -

Child 1. -

2. -

3. -

Dependents (Please state – Total, Relationship and Age) :

If there is an emergency situation, person we can contact (Please state – Name, Relationship, and Telephone Number) :

Name : GUSTIAN SAMURA Relationship : FATHER Telephone Number : +6281347240004

F/HRD-R&S/02 rev.00 – [2]

EDUCATION
Graduation
Education Institution Name Location Department GPA
Year

SMA KELUARGA JAKARTA IPS 2011

High School WIDURI SELATAN
-
Diploma/Academy
INDONESIA AL-AZHAR JAKARTA INTERNATIONAL CANDIDATE 2.78
Bachelor UNIVERSITY SELATAN RELATION
-
Master/Doctorate

LANGUAGE ABILITIES
Verbal Writing
Foreign Language
Poor Average Good Excellent Poor Average Good Excellent
1. ENGLISH X X

2. JAPANESE X X

REFERENCES (except family)

Name Company Position Telephone How Long Know You in What
Number capacity
1.AYU LARASATI INDONESIAN MENTORS +62812101843 3 YEARS AS WORK PRACTICE
MINISTRY OF WORK 88 UNIVERSITY
FOREIGN PRACTICE STUDENT
AFFAIRS
2. AKBAR SATRIA CLOUDLY OWNER +62815819524 2 YEARS AS EMPLOYEE
VAPORIZER 5
STORE

WORK EXPERIENCE (fill out from the latest job)

  
Company Name CLOUDLY VAPORIZER SACHER TORTE CAKE INDONESIAN
STORE STORE MINISTRY OF
FOREIGN AFFAIRS
Address JLN. CINERE RAYA B No. PONDOK INDAH MALL 2 JLN. PEJAMBON
30 CINERE DEPOK JAKARTA SELATAN JAKARTA PUSAT

Telephone Number - - -
Business Field VAPORIZER STORE CAKE STORE FOREIGN AFFAIRS

Entry Position

Period (From - To) 2016 - PRESENT (FEB-JUNE) 2016 OCT 2015 – JAN 2016

Number of Subordinate - - -

Last Position

Period (From - To) 2016 - PRESENT (FEB-JUNE) 2016 OCT 2015 – JAN 2016

Number of Subordinate - - -

Job Desc (Last Position) CUSTOMER RELATION & CHASIER WORK PRACTICE
MANAGEMENT -CARRY OUT
-PROMOTION TO TRANSACTIONS WITH
INCREASE CUSTOMER CONSUMERS
-SERVING CUSTOMERS -CREATE DAILY
-INTRODUCE PRODUCT EARNING REPORT
TO CUSTOMER

F/HRD-R&S/02 rev.00 – [3]

 -MAKE A REPORT OF
THE PURCHASE &
SALE/INCOME EVERY
DAY REPORT

Immediate Supervisor OWNER OUTLET MANAGER

Reason of Resignation 1. HOPING TO GET A FOCUS ON

DECENT JOB WITH COMPLETING THESIS
EDUCATIONAL LEVEL
2. LOOKING FOR BETTER
CHALLENGES &
EXPECTATIONS

Draw your latest position at your company’s organization structure

Working Achievement

1. INCREASE BUSINESS INCOME

2. HONEST AND RESPONSIBLE

3. -

F/HRD-R&S/02 rev.00 – [4]

OTHERS
Please state and explain the kind of job which fit into your career plan
THE KIND OF WORK THAT CAN MEET AND CONVINCE MANY PEOPLE OF VARIOUS ORIGINS AND ALSO CAN
PROVIDE BENEFITS FOR THE COMPANY
Please state and explain the kind of job you don’t like and feel reluctant to do
THE PASSIVE WORK AND JUST WAITING ORDER

Are you willing to undergo these things?

1. Psychology Test X Yes No

2. Probation Period X Yes No
3. Business Trip to Other Cities X Yes No
4. Placed at Different Location X Yes No

Please answer these questions :

Do you have a side job? If yes, state the name of your company and position Yes X No
……………………………………………..

Do you have relatives who work in our company? If yes, please state their name Yes X No
and relationship with you..…………………….........................

Have you ever / currently suffered severe illness or accident that makes you Yes X No
hospitalized? If yes, please state ……………………………………

Is it okay if we ask for reference from your previous company? X Yes No

If you are accepted, when can you start working? As soon as possible

I hereby declare that all the given information above is true. If I falsify information, I’m ready to accept all the consequences,
and Management have a right to terminate my employment or doing other necessary course of action. If I’m accepted, I
agree to abide by the rules and regulations of PT. Pelayaran Tempuran Emas, Tbk.

City Signature

JAKARTA

2 6 Date 0 8 Month 1 7 Year

MOHAMMAD ILHAM UTAMA

F/HRD-R&S/02 rev.00 – [5]

PT PELAYARAN TEMPURAN EMAS Tbk
& Subsidiaries
SALARY INFORMATION FORM

Name : MOHAMMAD ILHAM UTAMA

Applied Position : SALES / MARKETING

Salary in Previous / Current Company Expected Salary

Rp. 3.500.000 Rp. 5.500.000

F/HRD-R&S/02 rev.00 – [6]