CONFIDENTIAL

Beritasatu Plaza 9th & 11th floor, Jl. Gatot Subroto Kav.35-36, Jakarta 12950
Graha Investor Jl. Padang No. 19 – 21, Manggarai, Jakarta 12970

APPLICATION FORM
Date :      
(Tanggal)

Position Applied :      

(Nama Posisi)

Name
(Nama lengkap) :       Male Female

Address :      
(Alamat sesuai identitas)
     
(Alamat tempat tinggal :
Jika berbeda dengan identitas)

Telephone Number : (home)       (mobile)      

(Telepon)
(Rumah) (Hp)

E-mail Address :      

(Alamat e-mail)

Place / Date of Birth :       Identity Number :      

(Tempat/tanggal lahir) (No. KTP )

Religion :       NPWP Number :      

(Agama) (No. NPWP )

Ethnicity :       No. BPJS Ketenagakerjaan :      

(Etnis)
No. BPJS Kesehatan :

Status : Single Married Divorced

(Status) (Bujangan ) (Menikah ) (Bercerai )

Hobbies :       Blood Type :      

(Hobi ) (Golongan Darah)

Salary Desired : Rp       Date you can start working :      

(Gaji yang diminta) (Tanggal mulai bekerja)

Have you ever applied to / worked for Berita Satu Media Holdings before? Y or N
(Apakah sebelumnya Anda pernah berproses atau bekerja di Berita Satu Media Holdings) Ya / Tidak
If yes, please explain (include date):      
(Jika pernah, kapan waktunya dan jelaskan)

Do you have any friends, relatives, or acquaintances working for Berita Satu Media Holdings? Y or N
(Apakah Anda memiliki teman, saudara atau kenalan yang bekerja di Berita Satu Media Holdings) Ya / Tidak
If yes, state name & relationship:      
(Jika ada, cantumkan nama dan hubungannnya dengan Anda)

In case of emergency, notify (name)       Relationship:      

(Jika dalam keadaan darurat, (Hubungan)
nama yang bisa dihubungi)
Phone :      
(No. Telp)

FAMILY RECORDS (including you) (Data Keluarga, termasuk Anda )

1
 CONFIDENTIAL

Beritasatu Plaza 9th & 11th floor, Jl. Gatot Subroto Kav.35-36, Jakarta 12950
Graha Investor Jl. Padang No. 19 – 21, Manggarai, Jakarta 12970

Occupation
Relationship Name Age Education
(Hubungan) (Nama) (Usia) (Pendidikan)
(Pekerjaan)
Father (Ayah)                        
Mother (Ibu)                        
Siblings (Saudara)                        
                             
                             
                             

IF YOU ARE MARRIED (JIka Anda sudah menikah)

Relationship Name Date of Birth Occupation
(Hubungan) (Nama) (Tanggal Lahir) (Pekerjaan)
Spouse (Husband/Wife)                  
(Pasangan Suami/istri)
Children (Anak)                  
                 
                 

EDUCATION BACKGROUND (Latar Belakang Pendidikan)

No Name of School / University Faculty Year graduated GPA
(Nama Sekolah / Universitas) (Fakultas) (Tahun Lulus) (IPK)
1 University                        
2 University                        
3 Academy                        
4 High School                        

ORGANIZATIONAL EXPERIENCES (Pengalaman Organisasi)

No Name of Organizations Position Period
(Nama Organisasi) (Posisi) (Periode)
1                  
2                  
3                  
4                  
5                  

SEMINAR / TRAINING / COURSES (Seminar / Training / Kursus )

No Seminar Date Held by

(Seminar) (Tanggal) (Penyelenggara)
1                  
2                  
3                  
4                  
5                  

2
 CONFIDENTIAL

Beritasatu Plaza 9th & 11th floor, Jl. Gatot Subroto Kav.35-36, Jakarta 12950
Graha Investor Jl. Padang No. 19 – 21, Manggarai, Jakarta 12970

EMPLOYMENT HISTORY (Pengalaman Kerja)

Please list previous employers starting from the most recent. Attach additional sheet if necessary. Please do not substitute
with "see resume." (Silahkan tuliskan pengalaman kerja Anda dimulai dari yang paling akhir. Jika perlu, silahkan tambahkan
lampiran. Mohon jangan ditulis dengan “lihat resume”)

Company Name:       Position:      

(Nama Perusahaan) (Posisi)
Address:       Working Period:      
(Alamat) (Masa Bekerja)
Salary: Rp      
(Gaji)
Main responsibilities (Tanggung jawab) Phone:      
      (Telepon)
Reason for leaving (Alasan berhenti)
     

Company Name:       Position:      

(Nama Perusahaan) (Posisi)
Address:       Working Period:      
(Alamat) (Masa Bekerja)
Salary: Rp      
(Gaji)
Main responsibilities (Tanggung jawab) Phone:      
      (Telepon)
Reason for leaving (Alasan berhenti)
     

Company Name:       Position:      

(Nama Perusahaan) (Posisi)
Address:       Working Period:      
(Alamat) (Masa Bekerja)
Salary: Rp      
(Gaji)
Main responsibilities (Tanggung jawab) Phone:      
      (Telepon)
Reason for leaving (Alasan berhenti )
     

3
 CONFIDENTIAL

Beritasatu Plaza 9th & 11th floor, Jl. Gatot Subroto Kav.35-36, Jakarta 12950
Graha Investor Jl. Padang No. 19 – 21, Manggarai, Jakarta 12970

JOB RELATED SKILLS (Keterampilan Khusus)

Please list all job-related skills (incl. where applicable, office equipment operated, computer software skills, typing skills, etc.)
(Silahkan tuliskan keterampilan khusus yang berhubungan dengan pekerjaan)

     

LANGUAGE PROFICIENCY (Keterampilan Berbahasa)

Language Speaking Listening Writing Reading
(Bahasa) (Berbicara) (Mendengar) (Menulis) (Membaca)
English

PROFESSIONAL REFERENCES (Referensi Kerja)

List 3 people who is not related to you who can comment on your work performance
(Tuliskan 3 referensi yang tidak berhubungan secara langsung dengan Anda mengenai Pekerjaan Anda)

Name Address & Telephone Company Position Years Known

1.                              
2.                              
3.                              

I hereby acknowledge and affirm that I have read all questions and that my answers to them are true and correct
and that I have not misrepresented, withheld or omitted any information in this application or any other materials I
have submitted in connection with my employment application. I understand that falsification of this information or
any other information I submit is grounds for denial of employment or if hired, immediate dismissal.
(Dengan ini saya menyatakana bahwa jawaban yang saya berikan dalam aplikasi ini adalah sesuai dengan kenyataan, lengkap
dan benar. Setiap keterangan atau jawaban yang palsu, bohong dan tidak ujur dapat menjadi pemecatan atas diri saya )

Signature of Applicant,
(Tanda Tangan Pelamar)