PT APEXINDO PRATA

POSITION APPLIED : HSE Oficer DATE: June, 19 2018

APPLICATION FOR EMPLOYEMENT FORM

- The Content of this Form have no obligation for both parties
- This form should be completed in English

THE SOURCE OF INFORMATION FOR POSITION APPLIED (please choose)

1. Apexindo Website 4. On my own

2. Newspaper adv. 5. Apexindo Empoyee (please mention)
3. Friend/Relatives 6. Other (please mention)

PERSONAL DETAIL
FULL NAME : Rahmat Adi Saputra
DATE OF BIRTH : March, 16 1993
ID/PASSPORT NUMBER : 6402051603930001
ADDRESS : Jl. Am. Tahir Rt. 01 Desa Tj. Limau Kec. Muara Badak
CITY : Kutai Kartanegara COUNTRY: Indonesia
CONTACT NUMBER : HOME :
EMAIL ADDRESS : saputrarahmatadi@yahoo.co.id
NATIONALITY : Indonesia
MARITAL STATUS : Married

FAMILY DETAILS
No. Family Relation M/F Name Place & DOB
1 Father M Joko Maryono Trenggalek, 19 September 1963
2 Mother F Yatini Sanga-sanga, 8 January 1970
3 Spouse F Tika Aryanti N Muara Badak, 22 May 1992
4 Child/Sibling/Self
5 Child/Sibling/Self
6 Child/Sibling/Self
7 Child/Sibling/Self
8 Child/Sibling/Self

You are child number from total children of

FORMAL EDUCATION
Years
No. School/ University Name Formal Education
No. School/ University Name Formal Education
From To
1 SMA N 3 Tenggarong Sr. High School 2007 2010
2 Academy
3 STT MIGAS Balikpapan University 2010 2014
4 Post Graduate
5

INFORMAL EDUCATION, TRAINING, COURSE, SEMINAR

No. Institution Name Location Sucject/ Topic Month & Year

1 PUSDIKLAT MIGAS CEPU Blora, Jateng K3 MIGAS April 2016

2 VICO Indonesia Muara Badak Internship March 2013
3
4
5

FOREIGN LANGUAGES
No. Language Speaking
1 English Fair Good Excellent
2 Fair Good Excellent
3 Fair Good Excellent

No. Skill Name

1 Ms. Office
2 Photoshop
3
4
5

GENERAL INFORMATION
No. Strenght(s) Weakness(es)
1 Interest Not Cofident
2 Discipline
3 Responsibility
4 Honest
5 Excited

WORKING EXPERIENCES (START WITH CURRENT JOB, INCLUDING TEMPORARY WORK & VOCATIONAL TRAINING)

Name & Type of Rig

No. Company Name Position Rig Location Client (Land Rig, W/O, Jack Geothermal/Oil
Up, Semi, Tender) Project

1 PT. SUTINDO Inside Sales

 Inspection &
2 PT. MARINDOTECH HSE Officer VICO Indonesia
Certification

10

WORKING REFERENCES
No Name Company Name Location
1 Budianto PT. Halliburton Muara Badak
2 Nopriyadi PT. Marindotech Jakarta
3
4
5

GENERAL
Your expected salary on the position applied (Brutto / Nett) IDR 8.000.000,-
Are you willing to relocate? Yes / No (if No please explain)
Are you willing to travel? Yes / No (if No please explain)
Have you been or are you suffering from any serious physical disability or disease?

I declare that the above mentioned statements are true and ready for any retribution if company found impropriate data.

Rahmat Adi Saputra )

(signature of applicant)
PEXINDO PRATAMA DUTA TBK.
Gedung Office 8 lantai 20-21, SCBD Lot 28
Jl. Jend Sudirman Kav 52-53 Jakarta 12190
HUMAN RESOURCES DEPARTMENT

DATE: June, 19 2018

ORM

NICKNAME: Putra
PLACE : Sanga-Sanga

ZIP CODE : 75382

MOBILE : (+62) 812 5399 0065

ETHNIC: Java
RELIGION : Moeslim

Education Occupation
Undergraduate Teacher
Undergraduate Teacher
Post Graduate Teacher

Degree & Major Graduate NEM / GPA

 Degree & Major Graduate NEM / GPA
IPA Yes/No 7.8
Yes/No
Petroleum Eng. Yes/No 3.34
Yes/No
Yes/No

Date Of Certifacate
Certified Certificate
Attached
Validity
Yes/ No 21-Apr-21 Yes/No
Yes/ No Yes/No
Yes/ No Yes/No
Yes/ No Yes/No
Yes/ No Yes/No

Written
Fair Good Excellent
Fair Good Excellent
Fair Good Excellent

Level
Fair Good Excellent
Fair Good Excellent
Fair Good Excellent
Fair Good Excellent
Fair Good Excellent

Interest/ Hobby
Football/Futsal
Cycling
Coocking

OCATIONAL TRAINING)

Month & Years

Reason for
From To Leaving

2015 2016 End of Contract

 2016 2018 End of Contract

Position Title
ak Chemical Analyst
Crane Inspector

Yes/No (if Yes please explain below)

mpropriate data.