PHOTOGRAPH

(Please affix a
recent passport
sized photograph)

EMPLOYMENT APPLICATION FORM

Position Applied For: _______________________________________

PERSONAL PARTICULARS
Full Name : Mr/Mrs/Miss

Current Residential Address :

Permanent Residential Address (if different from above) :

Contact No. : (Home) (Office) (Mobile)

Age Marital Status

Sex Nationality

Date of Birth Religion

Place of Birth Email Address

Do you hold a valid driving license? YES / NO Class

SPOUSE PARTICULARS (husband/wife)

Spouse’s Full Name : Occupation :
Date of Birth: Contact No. : (Mobile) (Office)

Name & Address of Employer :

CHILDREN PARTICULARS
Name Birth Date & Year Occupation (if any)
FAMILY PARTICULARS (Parents, Brothers, Sisters)

Name Age Relationship Occupation Name of Employer (if

employed)
Father

Mother

Brother/Sister

Brother/Sister

Brother/Sister

Brother/Sister

LANGUAGE & DIALECT PROFICIENCY ( Please indicate : Poor / Moderate / Fluent )

Read Written Spoken
1. English
2. Bahasa

3.

EDUCATION BACKGROUND (In Chronological Order)

Date
Institution Name Major Grade
Joined Left
Elementary
Junior High
School
Senior High
School
Diploma

Bachelor

Master

Doctor / PHD

PROFESSIONAL TRAINING / CERIFICATION / PROFESSIONAL SKILL

(Including any training program by College, University, etc)
Type of Training/Professional Course Name of College/Training Date Results
Date (if any)
Attended/Skill Provider/Institute
CURRENT EMPLOYMENT PARTICULARS
Employer’s Name :
Nature of Business :
Address :

Present Position : Date of Commencement :

Number of staff under your our
Supervision (if any) Staff

Basic Salary
Allowance (please specify) (Rp. )
(Rp. )
(Rp. )
Other Benefits (please specify)

Previous Position : Date of Commencement :

Number of staff under your our
Supervision (if any) Staff

Basic Salary
Allowance (please specify) (Rp. )
(Rp. )
(Rp. )
Other Benefits (please specify)

Describe briefly the duties and responsibilities of your present position :

______________________________________________________
_____________________________________________________
_____________________________________________________
______________________________________________________
Reason for leaving : __________________________________________

Salary expected for this application : Rp.

Date available for employment :
DETAILS OF PREVIOUS EMPLOYMENT (In Chronological Order)
Last Drawn Date
Employer’s Name Position Reason for Leaving
Salary Joined Left
 Other information which you consider important and helpful to us is assessing your suitability for the
position that you have applied for.
________________________________________________________
________________________________________________________
________________________________________________________
________________________________________________________

CORPORATE REFEREES ( immediate superiors from previous employment )

Full Name : Full Name :

Address : Address :

Occupation : Period Known : Occupation: Period Known :

Contact No. : (Mobile) Contact No. : (Mobile)

(Office) (Office)

DECLARATION
1. Have you ever been charged and convicted in any Court of Law or detained under the YES / NO
provisions of any written law?
2. Have you ever been terminated / dismissed by your previous employer? YES / NO
3. Are you suffering or have you suffered any mental illness, physical handicap or disability? YES / NO
If yes, please specify ( )

4. Are you currently under any medication / treatment for any serious ailment/illness/disease? YES / NO
If yes, please specify ( )
5 Are you pregnant now? (for female applications only) YES / NO
6. Have you applied for a job in this company before? If so, when? YES / NO
________________________
7.Do you have any relatives or friends working in PT. Tech Data Advanced Solutions Indonesia YES / NO
If yes, please give details
Name Relationship Position in Company

I, hereby declare that all particulars given above are to the best of my knowledge, true and correct. This declaration
shall, if I am employed, constitute an integral part of the Contract of Service between the company and I. I agree
that if the Declaration is in any part false or incorrect, the company reserves the right to terminate my services
instantly. I also understand that the Company would be conducting background / reference checks on my previous
employers and I would not hold the Company liable for any problems / issues arising from these checks if it directly
/ indirectly affects my current employment status

________________________________ _____________________________
Signature of Applicant Date