Yayasan Citra Mulia Nusa Bangsa

EMPLOYMENT APPLICATION FORM

Date of Interview/ With: _________________ /______________________

HIRED/KIF/REJECTED
Position Applied for : ________________________
Expected Gross Salary*
(*must be stated) : ________________________ Available Date : ______________________
Applicant’s Name : ________________________ Gender : ______________________
Address : ___________________________________________________________ ____
_________________________ Telephone/HP : ______________________
Date/Place of Birth : _________________________ / ____________________________________
Religion : _________________________ When : ______________________
Marital Status : Single Married Separated Divorced Widowed

FAMILY DATA
NAME AGE OCCUPATION
Husband/Wife : _________________________ ____________ ____________________
Father : _________________________ ____________ ____________________
Mother : _________________________ ____________ ____________________
Brother/Sisters : _________________________ ____________ ____________________
_________________________ ____________ ____________________
_________________________ ____________ ____________________
Children : _________________________ ____________ ____________________
_________________________ ____________ ____________________
_________________________ ____________ ____________________

PROFESSIONAL PREPARATION

School/College/University Year Certificate/Diploma

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Major Subject: _____________________________ Minor Subject: __________________________________
College distinctions or honors: ___________________________________________________________________
Valid teaching or administrative credentials held: ____________________________________________________

OFFICE SKILLS: LANGUAGE:

Typing Computer Spoken: __________________________________
Other _______________ Written: __________________________________
Are you prepared to teach Bible subjects and principles? (Please amplify): ________________________________
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Able to teach art: ____________________________ Music: ________________________________________
Handcrafts: _________________________________ Other: ________________________________________
Piano or other musical instrument played : _______________________________________
Special school activities you can conduct : _______________________________________
Typical books and periodical read during leisure time :_______________________________________
Educational and professional organization membership held : _______________________________________
Do you have a heart for ministry? (Please amplify): ___________________________________________________
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Do you have a burden to serve in the church? _______________________________________________________
What do you expect from this job? ________________________________________________________________
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What do you expect from our institution? __________________________________________________________
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EMPLOYMENT HISTORY
(Beginning with most recent position)
PRESENT SITUATION
Name of Company : ___________________________________ Date joined: _____________________
Address : ________________________________________________________________________
___________________________________ Telp : ____________________
Position held : ________________________________________________________________________
Salary : ________________________________________________________________________
Reason for leaving : ________________________________________________________________________
PREVIOUS EMPLOYMENT

Name of Company Position Year Salary Reason For Leaving

Person to whom we may write for reference:

NAME Address / Phone Number Position
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PASTOR’S REFERENCE:
Church attended : _________________________________________________________________
Pastor’s name : _________________________________________________________________
Date joined : _________________________________________________________________

Please tell us about your experience when you were born again.
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What is the purpose of your life?
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Strengths:
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Weaknesses:
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Job Desc:
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Date: _______________________

(Applicant Signature)
For Office Use Only:
Dept. / Position : ________________________________________________________________
Starting Date : ________________________________________________________________
Salary : ________________________________________________________________
Others : ________________________________________________________________
Remarks : ________________________________________________________________
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