EMPLOYEE APPLICATION FORM

F – HRD/REC/0___/__/201_

The following information will help us assess your employment opportunity with PT. Sayap Garuda Indah (hereinafter
called the “Employer”). All portions of this application pertaining to you must be completed. We appreciate the time you
spend in completing this application form.

Position applied for : _______________________________

Recent
Other position(s) you would like to be considered for : ___________________ photograph
3 X 4 cm
Salary expectation : _______________________________

Available starting date : _______________________________

PERSONAL DATA
Full name : Male Female
Nick Name :
Place / Date of Birth :
Current Address :

Nearby :
City : Post code:
Permanent Address :

Nearby :
City : Post code:
Mobile Phone 1 :
Mobile Phone 2 :
Home Phone :
Personal Email :

BPJS TK Number : BPJS Kes Number :

NPWP Number :
Driving Licence Number : A: C:
I.D. Card Number : Date of Expiry :
Marital Status : Single M-0 M-1 M-2 M-3
Religion : Blood Group :
Height / Weight : Hobby :
Allergic :
EDUCATION AND TRAINING
Name and address of school, University or From To Degree or
Major Course or Study
other Training Institutions. (MM/YY) (MM/YY) Certificate
OTHER ACTIVITIES
Name of Organisation From date To date Status

RECORD OF PREVIOUS EMPLOYMENT

1. Company Name : ____________________________________________ Telephone : _____________________
Address : _________________________________________________ Position : _____________________
Duties : _________________________________________________________________________________
_________________________________________________________________________________
Nature of Business : _____________________________________
Employment dates : from ____________ to ____________ Supervisor’s Name : ______________________
Salary : _________________________________
Reason for leaving : _________________________________________________________________________

2. Company Name : ____________________________________________ Telephone : _____________________

Address : _________________________________________________ Position : _____________________
Duties : _________________________________________________________________________________
_________________________________________________________________________________
Nature of Business : _____________________________________
Employment dates : from ____________ to ____________ Supervisor’s Name : ______________________
Salary : _________________________________
Reason for leaving : _________________________________________________________________________

3. Company Name : ____________________________________________ Telephone : _____________________

Address : _________________________________________________ Position : _____________________
Duties : _________________________________________________________________________________
_________________________________________________________________________________
Nature of Business : _____________________________________
Employment dates : from ____________ to ____________ Supervisor’s Name : ______________________
Salary : _________________________________
Reason for leaving : _________________________________________________________________________

REFERENCES (Non – Relatives)

1. Name : ______________________ Telp/Mobile: _________________ Company : ______________________
E-Mail : __________________________________________________ Years Known : __________________

2. Name : ______________________ Telp/Mobile: _________________ Company : ______________________

E-Mail : __________________________________________________ Years Known : __________________

3. Name : ______________________ Telp/Mobile: _________________ Company : ______________________

E-Mail : __________________________________________________ Years Known : __________________

LANGUAGE PROFICIENCY
Language skills (Language spoken) :
Language Speaking Reading Writing
English Poor Good Excellent Poor Good Excellent Poor Good Excellent
..................................... Poor Good Excellent Poor Good Excellent Poor Good Excellent
..................................... Poor Good Excellent Poor Good Excellent Poor Good Excellent

FAMILY RECORD
Husband/Wife’s name: ____________________________ Place/DOB : _____________ Occupation : _________
First child : __________________________________ Place/DOB : _________________ Male Female
Second child : __________________________________ Place/DOB : _________________ Male Female
2
Third child : __________________________________ Place/DOB : _________________ Male Female

Contact person in case of emergencies : _____________________________ Telephone : _________________

GENERAL INFORMATION

Are you presently employed ? Yes No

Have you ever been discharged from employment? If yes, please explain
______________________________________________________________________________________________
______________________________________________________________________________________________

Have you any objection to our contacting your previous employers ? Yes No
Have you had any serious illnesses, injuries or operations within the last five (5) years? If so, please describe
______________________________________________________________________________________________
______________________________________________________________________________________________

Have you had been involved any accidents or losses (aviation) in the last five (5) years? Yes No
If Yes, please describe.
______________________________________________________________________________________________
______________________________________________________________________________________________

Have you had any criminal convictions or violations in the last five (5) years? Yes No If Yes, please describe.
______________________________________________________________________________________________
______________________________________________________________________________________________

Have you ever suffered from any of the following illnesses?

Tuberculosis Yes No Heart Disease Yes No
Hypertension Yes No Diabetes Yes No
Venereal Disease Yes No Epilepsy Yes No
Hepatitis Yes No HIV/AIDS Virus Yes No

DECLARATION :
I certify that all statements made on this application are true and complete to the best of my knowledge. I understand
that misrepresentation or omission when discovered, will subject me to discharge and I hereby authorize any
investigation relating to my work experience, education, or reputation for the purpose of my application for
employment.

_________________ _________________
Applicant' signature Date