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Form Data Isian Pegawai V2 (English) - Revisi 01
Form Data Isian Pegawai V2 (English) - Revisi 01
HRD/FRM/2019/XI/001/Ver 1.00 1 /8
Recent Photo
(3x4)
CANDIDATE APPLICATION FORM
(Please fill with CAPITAL letter)
PERSONAL PROFILE
Ethnic ✔ Bataknese | c
c ✔ Javanese | c
✔ Sundanese | c
✔ Chinese | c
Manadonese
✔ Others : __________________________ )*
Religion ✔ Buddhist | c
c ✔ Hindu | c
✔ Moslem | c
✔ Catholic | c
✔ Christian | c
✔ Others : ____________________
)*
Current Address JL. Palmerah Selatan. RT.004 / RW.001. Kecamatan Tanah Abang, Kelurahan Gelora
District : Central of Jakarta Province : DKI Jakarta
Ownership ✔ Own | c
c ✔ Boarding | c
✔ Parents | c
✔ Relatives | c
✔ Rent | c
✔ Others : ____________________________ )*
)* Please gives check sign (P)
FAMILY MEMBER
Relationship Complete Name Gender Birthplace, Date of Birth Education Phone Number
Brother / Sister
Brother / Sister
NUCLEAR FAMILY
Relationship Full Name Gender Birthplace, Date of Birth Education Phone Number
Husband L
Wife P
Child
HRD/FRM/2019/XI/001/Ver 1.00 2 /8
REFERENCE
(Please fill with superior level or HR name in latest company)
EDUCATION
Degree Institution City Major From Until Title GPA
WORKING EXPERIENCE
(Starting from the latest company)
Company Name
Position
Bussiness Type
Supervisor Name
Latest Salary
Allowance
Exit Reason
Company Name
Position
Bussiness Type
Supervisor Name
Latest Salary
Allowance
Exit Reason
HRD/FRM/2019/XI/001/Ver 1.00 3 /8
Starting Work Period Until
Company Name
Position
Bussiness Type
Supervisor Name
Latest Salary
Allowance
Exit Reason
Job Applied
| 1. | or | 2.
Expected Salary
| Rp. | until | Rp.
Join Date
|
FOREIGN LANGUAGE PROFICIENCY
Level of Mastery
Foreign Language (Poor, Fair, Good, Excellent)
Speaking Listening Writing Reading
EXPERTISE
Please gives check sign (P)
1. Project Management v
2. Marketing Solution v
3. Marketing Strategy v
4. Team Work Skill v
5. Communication Skill v
6.
7.
OTHER INFORMATION
SOCIAL ACTIVITY / ORGANIZATION
(Including organization's name, position/level, active period, and location)
BENIH BAIK FOUNDATION
2020
INTEREST / HOBBY
(Including organization's name, position/level, active period, and location)
HEALTH
(Including organization's name, position/level, active period, and location)
HRD/FRM/2019/XI/001/Ver 1.00 4 /8
OTHER QUESTION
Please circle which applied
No I don't
6. What is your relationship with those names?
ASPIRATION
(Including desire, hope, or ambition in life)
HRD/FRM/2019/XI/001/Ver 1.00 5 /8
Please draw a chart to explain your recent / latest position level in the organizational structure
(Please write a short essay about your job description in your latest workplace)
HRD/FRM/2019/XI/001/Ver 1.00 6 /8
PERNYATAAN AUTENTIFIKASI INFORMASI
Saya menyatakan dan menjamin bahwa semua informasi di atas adalah benar dan saya tidak menyembunyikan fakta yang sesungguhnya.
Saya memberikan kewenangan kepada Pulauintan untuk menghubungi semua pihak yang bersangkutan untuk keperluan verifikasi dan
untuk mendapatkan informasi lainnya mengenai saya secara lisan maupun tertulis dari waktu ke waktu apabila hal itu dianggap perlu.
Apabila dikemudian hari ditemukan bahwa data yang saya sampaikan diatas tidak benar dan/atau ada pemalsian, maka saya bersedia
dihilangkan haknya sebagai karyawan Pulauintan dan dikenakan tuntutan perdata dan pidana sesuai ketentuan hukum dan perundang-
undangan yang berlaku.
Jakarta, ____________________
________________________________
Nama lengkap
HRD/FRM/2019/XI/001/Ver 1.00 7 /8
FORM KELENGKAPAN KARTU KARYAWAN
*diisi oleh HRD
HRD/FRM/2019/XI/001/Ver 1.00 8 /8