APPLICATION CONFIDENTIAL

FORM
USE CAPITAL LETTERS

PT. RADITA HUTAMA INTERNUSA

A division of Charles Taylor adjusting RECENT
PHOTOGRAP
Gedung Artha Graha, 22nd floor, H
Jl. Jend. Sudirman Kav.52-53 Jakarta 12190 Indonesia
T: +6221 2971 7171 | F: +6221 5152085
www.ctplc.com/adjusting
APPLIED FOR POSITION:
PERSONAL DETAILS
Full Name Nick Name

Place / Date of Birth Sex Male / Female *)

Religion Marital Status Single / Married / Others *)
Current Address City
Province
Zip Code
Phone Email
Cellular ID Card No.
*) Choose one

FAMILY DETAILS (including You)

Member Name Sex Age Education Job / Company Phone Number
Father
Mother
1st Child
2nd Child
3rd Child
4th Child
5th Child

Member Name Sex Age Education Job Company

Spouse
1st Child
2nd Child
3rd Child

EDUCATION AND SKILLS

A. Formal Education
Year
Level of Education Institution / Location Major GPA
Entry Graduate
Elementary
Junior High School
High School
Diploma
College
Postgraduate

HRD 2021
B. Non Formal Education : Course / Training / Seminar
Field / Kind Held by Level Year Paid by

C. Achievement
Field / Kind Honor Level Year Given by

C. Languages
Listening & Speaking Reading
Foreign Language
Fluent Fair Slight Fluent Fair Slight

D. Computer Skills
Ability
Program / Application
Excellent Good Fair Poor

E. Hobby
Exercise Time
Hobby
Routine Frequent Rare Never

F. Organizational Experience
Organization Name Field / Kind Year Position / Role

G. Social Media Platform

Social Media User Name Email
Facebook
Twitter
Instagram
Linkedin
WORK EXPERIENCE (starting from present job)

Company Name Latest Position

Address Supervisor
Phone Director
Type of Business Period of Employment to
Total Employees Net Salary
Reason for leaving (specific)

List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company

Company Name Latest Position

Address Supervisor
Phone Director
Type of Business Period of Employment to
Total Employees Net Salary
Reason for leaving (specific)

List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company

Company Name Latest Position

Address Supervisor
Phone Director
Type of Business Period of Employment to
Total Employees Net Salary
Reason for leaving (specific)

List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company

ORGANIZATIONAL STRUCTURE
Draw the organizational structure of your latest position
Organizational Structure
REFERENCE
References and recommendations about you can be obtained from (other than family):
Name Company Position Relationship Phone Number

OTHER INFORMATION
1. Desired monthly salary (take home pay)? fixed/negotiable*
2. Earliest date able to commence employment?
3. Will you be available for overtime work, including weekends?
4. Will you serve out of the city?
5. Will you be available for working in all branch office?
6. Have you had a rather severe illness/accident?
If yes, please describe
7. Does it have a side effect presently?

I hereby declare that the information I have provided above is true and correct. Whenever there was untruth, I will
take full responsibility for the consequences.

………. , ……………………….. 2020

Signature,

( )
 INTERVIEW RESULT
ASPECTS Excellent Good Fair Poor

PERSONALITY Explain :
( Responsibility, Maturity, Attitude )

CAPABILITY Explain :
( Job Knowledge, Relevant Experience, Expertise, Skills )

INITIATIVE Explain :
( Creative Problem Solving, Independent )

MOTIVATION Explain :
( Eager to Learn, Enthusiastic, Optimistic )

PHYSICALAPPEARANCE Explain :
( General Health, Tidiness, Disability )

OVERALLEVALUATION Explain :

Note : STRONGLY RECOMMENDED

RECOMMENDED
CONSIDERED
REJECTED
Interviewed by :

Date :
Interviewed by :

Date :