REFERENCE REQUEST FORM

YKI is considering employing this person, who has given us your name to provide a pre-employment
reference. This information will be used as part of our decision-making process.
Please take a little time to complete the following questions. But do feel free to expand/emphasise on
these and other areas as you feel appropriate.

NAME OF CANDIDATE : Rerin Alfredo Sulaiman

POST APPLIED FOR : Technical Officer – Kabupaten Bekasi

NAME, ORGANISATION & JOB TITLE OF REFEREE : dr Alfian – Supervisor, RSUD Kabupaten
Batang

Background
What is your relationship with this person?
E.g. friend, colleague, direct line manager/supervisor of the potential recruit; or did they manage you?
Teman dan Kolega

How long have you known this person?

Hampir 2 tahun

What was this person’s job title with your organisation?

Dokter umum

When did they start / finish working with your organisation?

Maret 2018 – November 2018

Professional / Technical Ability

Confirm dates of work and positions held to the best of your knowledge.

What was their initial / final salary in?

 Initial Salary : Rp 3,150,000
 Final Salary : Rp 3,150,000
What is your assessment of their professional abilities?
Dia mampu dalam bidangnya

Describe how their skills would fit those required for this post
Saya rasa dalam posisi technical officer, membutuhkan disiplin yang tinggi, kreatifitas yang tinggi,
integritas yang baik, pengetahuan yang baik dalam bidangnya, dan Saudara Rerin memiliki itu
Have they managed any staff? If so, how many?

Describe their supervising / management style

Seorang yang teratur dalam manajemen waktunya.
Menyelesaikan tugas dan kewajiban tepat waktu.

Did they have Budget management responsibilities? If so, describe the size of budgets managed and
their capabilities in budget management.
Tidak

Describe any language skills they have

Bahasa Inggris

Describe their written & verbal communications skills

(1. Poor – 5. Expert)
1.  2.  3.  4. 5. 
5
Describe their IT skills (word processing, spreadsheets, databases etc)
(1. Poor – 5. Expert)
1.  2.  3.  4. 5. 
4
Personal
How well did they work in the team?
Bagus, bisa bekerja sama dengan baik, memiliki dedikasi dan loyalitas yang baik

Were they able to work independently and on their own initiative?

Bisa. Karena dia mempunyai kreatifitas dan inovasi yang bagus

How well did they cope with stressful situations? Can you please give an example?
Menurut penilaian saya, Rerin mempunyai Manajemen prioritas yang baik sehingga dia bisa memberi
keputusan dalam situasi yang sulit
Were they punctual, i.e. on time for meetings and engagements, and meeting work deadlines?
Sangat tepat waktu

To the best of your knowledge how many days off due to sickness did the candidate take during the
last 12 months with you?
(Note you cannot discuss medical history without the candidate’s permission)
Tidak pernah

Do you know if they had other absences?

Tidak ada

Line Manager Referee only:

Were there any disciplinary or performance issues?
Tidak ada

General Points
Are there any other points you would like to make in connection with this potential recruitment by
KNCV?
Mempunyai jiwa leadership.
Disiplin
Mempunyai pola pikir yang baik
Humble
Komunikator yang baik

How would you summarise their:

Strengths
 Skill Komunikasi
 Disiplin
 Kreatifitas
 Integritas

Weaknesses
 Tidak Terpikirkan

What are the candidate’s main competencies and skills relevant to this post?
Memiliki disiplin yang tinggi, kreatifitas yang tinggi, integritas yang baik, pengetahuan yang baik
dalam bidangnya

For a Previous Employer

Would you rehire this person?
Mau sekali

Thank you for completing this reference and for returning it promptly.

IF THE REFERENCE CONDUCTED THROUGH TELEPHONE, DETAILS OF PERSON TAKING REFERENCE

NAME : ………………………………………
POST : ………………………………………
SIGNATURE : ………………………………………
DATE : ………………………………………