FORM KELENGKAPAN DATA KARYAWAN

Nama Marcella Kawilarang, S.E.

NIK 317106501990001
Posisi SALES / MARKETING INTERN
Departemen MARKETING

No. Item (√)

1 Form Isian Data Pelamar ✔
2 Surat Lamaran Kerja
3 Curriculum Vitae ✔
4 Pas Foto ukuran 3x4 ✔
5 Fotokopi KTP ✔
6 Fotokopi NPWP
7 Fotokopi Kartu Keluarga ✔
8 Fotokopi Surat Ijin Mengemudi/ SIM ( √ )
Sim A SIM B SIM C
9 Fotokopi Kartu BPJS Ketenagakerjaan / Jamsostek
10 Fotokopi Kartu BPJS Kesehatan
Fotokopi Ijasah dan Transkrip Nilai Pendidikan Terakhir
Ijasah ( √ ) Transkrip ( √ ) Ijasah ( √ ) Transkrip ( √ )
11 S2 SMA/SMK * ✔
S1 ✔ SMP ✔
D3 SD ✔
12 Surat Keterangan Berbadan Sehat
13 Surat Keterangan Domisili RT s/d Kelurahan (bagi kost/ kontrak)
14 Fotocopy Rekening BCA yang masih aktif
a.
b.
c.
d.
e.
15 Dokumen Pendukung Lainnya
a.
b.
c.
d.
e.

* Semua dokumen diatas wajib dilengkapi

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 Recent Photo
(3x4)
CANDIDATE APPLICATION FORM
(Please fill with CAPITAL letter)

PERSONAL PROFILE

Full Name Marcella Kawilarang

Nick Name Marcella
Gender ✔ Male | c
c ✔ Female )*

Body Height & Weight 156

_________ 45
Cm ___________Kg
Blood Type ✓ O | c
c ✔ A | c
✔ B | c
✔ AB )*
Birthplace & Date of Birth
Jakarta, 25 January 1999
Nationality ✔ Indonesian | c
c ✔ Foreigner )*

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 : ____________________
)*

Marital Status ✔ Single | c

c ✔ Married | c
✔ Divorce
)*

Cellphone Number 0877-82516895

Phone Number 021-53673417
E-mail marcellakwlr8@gmail.com
NPWP Number -
ID Card Number 3171076501990001
ID Card Address JL. Palmerah Selatan. RT.004 / RW.001. Kecamatan Tanah Abang, Kelurahan Gelora
District : Central of Jakarta Province : DKI Jakarta

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

Father Ferdy Maria Kawilarang Male Jakarta, 23 June 1961 S1

Mother Leni Sunarto Female Jakarta, 19 October 1966 S1
Brother / Sister

Brother / Sister

Brother / Sister

NUCLEAR FAMILY
Relationship Full Name Gender Birthplace, Date of Birth Education Phone Number
Husband L
Wife P
Child

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 REFERENCE
(Please fill with superior level or HR name in latest company)

Name Department Relationship Phone Number

EDUCATION
Degree Institution City Major From Until Title GPA

Elementary School Regina Pacis Elementry School Jakarta 2005 2011

Junior High School Regina Pacis Junior High School Jakarta 2011 2014
Senior High School Regina Pacis Senior High School Jakarta 2014 2017
Diploma

Bachelor University of Pelita Harapan Tangerang Marketing Management 2017 2021

Post Graduate

WORKING EXPERIENCE
(Starting from the latest company)

Starting Work Period Until

Company Name

Position

Bussiness Type

Address & Phone Number

Supervisor Name

Latest Salary

Allowance

Exit Reason

Starting Work Period Until

Company Name

Position

Bussiness Type

Address & Phone Number

Supervisor Name

Latest Salary

Allowance

Exit Reason

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Starting Work Period Until

Company Name

Position

Bussiness Type

Address & Phone Number

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

English Good Excellent Good Excellent

EXPERTISE
Please gives check sign (P)

Type of Skills Beginner Intermediate Advance

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)

Cooking, Traveling, Community Involvement, Watching Cinema, Gym

HEALTH
(Including organization's name, position/level, active period, and location)

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 OTHER QUESTION
Please circle which applied

1. Have you ever following psychological testing before? Yes / No

If yes, when and what is the purpose?

In September 2021, for Job Requirement

2. Are you willing to follow medical check up? Yes / No

3. Are you willing to follow 3 month probation? Yes / No

4. Are you willing to be placed in other city? Yes / No

5. Do you know any employee in this company? If yes, who is it?

No I don't
6. What is your relationship with those names?

ASPIRATION
(Including desire, hope, or ambition in life)

PRINCIPLE / LIFE PHILOSOPHY

STRENGHT AND WEAKNESS

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 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)

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 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

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 FORM KELENGKAPAN KARTU KARYAWAN
*diisi oleh HRD

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