PT KOKOH INTI AREBAMA

Gd. Cowell Tower / Graha Atrium Lt.2 JOB APPLICATION FORM

Jl. Senen Raya No.135 Jakarta 10410
Tlp. (021) 350 6227, Fax (021) 386 2374 HRD Department

 Fill this job application form clearly, complete and detail specified.
 All the questions must be filled correctly, if someday proven that the data is incorrect, then you
considered
giving fake information or information that has been forged and this process considered to be cancel.
 Fill by hand writing and using capital letters Pas Photo
 Enclosed one Pas Photo with size 3X4 3x4
 If you have questions in filling this form, asked the recruiter.

1. POSITION APPLIED

Position : _______________________________________________________________________

2. PERSONAL DATA

Full Name : _____________________________________________________________________________

Sex : Male / Female *) (striketrough the unnecessary)

Date of Birth : _____________________________________Place _____________________________________

Child : Only child / First / Second / Third / ______ *) (striketrough the unnecessary) from _____ siblings
Religion : _____________________________________Nation ____________________________________
Height : _________________________________Cm Weight: _________________________________Kg
Last Education : Senior High School / Academy / University / Post Graduate *) (striketrough the unnecessary)
Maritial Status : Single / Married / Widower / Widow *) (striketrough the unnecessary)

Child Dependent : ________________________________________________________________________ person

Blood Type : ______________________________________________________________________________

ID Card Number : ______________________________________________________________________________

NPWP Number : ______________________________________________________________________________

Driving Lisence : C / A / B I / B II (striketrough the unnecessary) Driving Lisence No. : _________________________

Current Address : ______________________________________________________________________________

______________________________________________________________________________

Telephone : Home _______________________________HP. ______________________________________

E-Mail Address :______________________________________________________________________________

In case of emergency, family, address, phone number that can be contacted:

Name : _____________________________ Family Relation: ____________________________________
Job : ______________________________________________________________________________
Current Address : ______________________________________________________________________________

______________________________________________________________________________

Telephone : Home________________________________HP. ______________________________________

3. LATEST EDUCATION
Year
Education Level Name and the place of the school Major
Start Graduate

4. WORKING EXPERIENCE

Time of work (year)

Name of the company Position Last Salary Review Reason for Leaving
from untill

5. LANGUAGE SKILL
Language Reading Writing Speaking
1. English
2.

6. PARENTS
NAME AGE EDUCATION JOB
1.
2.

7. SIBLING (Include You)

NAME AGE EDUCATION JOB
1.
2.
3.
4.
5.

8. FAMILY LIST (Please Fill In If You Are Married)

NAME AGE EDUCATION JOB
Husband/Wife
1st Child
2nd Child
3rd Child
4th Child

9. STRENGTH AND WEAKNESS (Personality)

 STRENGTH
1.
2.
3.
1. Are you at the moment still working
2. Remuneration package expected
3. When you are available to work
4. Do you able to be placed in our plant
5. Do you have relatives who works here
Here with I declare that all the data I have written above is true and accurate, if the data proved not true or fake, can cause my
application to be rejected or if I have worked can be terminated right away.
Jakarta, ___________________________
__________________________________
Applicant’s Signature
WEAKNESS
: Yes / No *) (striketrough the unnecessary) Where: ____________________
: ________________________________________________________________
: ________________________________________________________________
: Yes / No *) (striketrough the unnecessary)
: Yes / No *) (striketrough the unnecessary) Name: ____________________
Conclusion:
1. Processed
2. Not Processed
Comments and reason:
_____________________________________________________
___________________________________________________
___________________________________________________
Date, _______________________________________________