EMPLOYMENT APPLICATION FORM

3x4

Position Applied :

PERSONAL DATA
Full Name
Place/Date of Birth
National ID Number
Marital Status
Email Address
Phone Number
Permanent Home Address (based on your National Current Home Address (if different from Permanent Home
ID Number) : Address) :

Phone Number : Phone Number :

FAMILY BACKGROUND
Name Place/Date of Birth Gender Education Occupation
Father M/F*
Mother M/F*
1st Child M/F*
2ndChild M/F*
3rd Child M/F*
4th Child M/F*
5th Child M/F*

Spouse M/F*
1st Child M/F*
2nd hild M/F*
3rd Child M/F*
4th Child M/F*
*mark that fit your family

Please list 3 persons that we can contact, in case of emergency

Name Relationship Address Phone Number
EDUCATION
Formal Education
School/ Institution Start – Finish
Faculty Major Location GPA
Name Year
Diploma
I/II/III*
Bachelor
Master
Doctoral
*mark that fit your education

Informal Education / Training / Course / Seminar

No Subject / Topic Duration Provider Certificate
1. Yes/No*
2. Yes/No*
3. Yes/No*
4. Yes/No*
5. Yes/No*
*mark that fit you

SKILLS
Language (foreign language)
N Write Speak
Language
o Poor Fair Good Poor Fair Good
1.
2.
3.

JOB EXPERIENCES
(Start from the latest)
Leave
Company Name Position Join Date Salary
Date

Supervisor’s May HR contact

Supervisor’s Name Supervisor’s Email
Phone Number your Supervisor?

Were you a Supervisor in this position? Yes/No

If yes, how many people did you supervise?

Summary of Job Description Reason For Leaving

 Leave
Company Name Position Join Date Salary
Date

Supervisor’s May HR contact

Supervisor’s Name Supervisor’s Email
Phone Number your Supervisor?

Were you a Supervisor in this position? Yes/No

If yes, how many people did you supervise?

Summary of Job Description Reason For Leaving

Leave
Company Name Position Join Date Salary
Date

Supervisor’s May HR contact

Supervisor’s Name Supervisor’s Email
Phone Number your Supervisor?

Were you a Supervisor in this position? Yes/No

If yes, how many people did you supervise?

Summary of Job Description Reason For Leaving

INTEREST
In which division and position are you interested for the future?

Where do you know about Veda Praxis and where you know the job vacancy from?

Please explain, why you want to work in Veda Praxis?

Are you willing to travel outside Jakarta? Yes / No (please explain)

If Yes, how often are you willing to travel? (Please select from below options)
 Anytime Once a Week Twice a Month Once a Month
Are you willing to work overtime? Yes / No (please explain)

If Yes, When will be the latest time you are willing to work? (Please select from below options)
Anytime After Midnight 23.00 21.00 19.00

Please mention the salary and benefit expectation.

Current Monthly Salary Desired Monthly Salary
Net / Gross* Net / Gross*
Current Benefit Desired Benefit
Benefit Amount Benefit Amount

SOCIAL ACTIVITY
Organization Activities
N DD-MM-YY –
Organization Name Position Place
o DD-MM-YY
1.
2.
3.
4.
5.

Please mention your hobbies!

What would you do in your spare time?

OTHER INFORMATION
Have you applied to Veda Praxis before ? If yes, please mention the time and position applied.

Do you have relatives and or friends who worked in Veda Praxis? If yes, please mention the
name(s) and relationship(s).

Do you also apply to any other company? If yes, please mention the company and position
applied.

Do you have any part-time jobs? If yes, please explain.

Have you ever had serious illness or undergone surgery or gotten into serious accident ? If yes,
please explain.
Do you have any serious illness that require specific condition for working ? If yes, please
explain.

In your opinion, what is your 5 strength ?

In your opinion, what is your 5 weakness that you need to improve ?

Please mention further information which may be helpful in considering your qualifications.

I hereby certify that all the information given above are true and if under any circumstances
omission or misrepresentation is found, I understand that I shall be fully held responsible.

Date :
Applicant Signature

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