EMPLOYMENT APPLICATION FORM

PT. XXXXXX

PERSONAL INFORMATION

Last Name : ADHYAKSADIPUTRA First Name : LUTHFI

Address : GEMA PESONA ESTATE BLOK R NO. 14 JL. TOLE ISKANDAR 45, DEPOK 2 TENGAH JAWA BARAT

Phone : (+62) 85716640161

Email : luthfi.adhyaksadiputra@gmail.com

EMPLOYMENT EXPERIENCE
(List most recent experience first)

NAME POSITION(s) HELD ADDRESS PERIOD (Start - End) SALARY NET THP

- - - - -

Copy of recent salary slip should be available upon request

REFERENCES
NAME PHONE EMAIL ADDRESS RELATIONSHIP
Vida Nugroho (+62) 81384121190 vida.noegroho@hudhud.co.id Cousin

Please provide Computer and Software knowledge below :

VULCAN
PHASE 2
SLIDE
ARCGIS
CORELDRAW
WORD, EXCEL, POWERPOINT

Notice Period (Amount of days before you can start or prefered start date)
MONDAY, MARCH 21 2021

I hereby declare that the information provided is true and correct. I also understand that any willful dishonesty may render for refusal of this application or immediate termination of
employment

Signature: Salary Expectation : net

COMPANY REGULATION
THP

Date : MARCH 17 2021