PT.

Hyundai Motor Manufacturing Indonesia

Menara Jamsostek Lt.5 South Tower, Jalan Gatot Subroto No. Kav.38
Kuningan Barat Mampang Prapatan , Jakarta Selatan, DKI Jakarta 12710 Indonesia
Indonesia Telp. (+62) 021-3118 2400, Fax (+62) 021-2525 620

EMPLOYMENT APPLICATION FORM

1.POSITION APPLYING FOR

2.EMPLOYEE INFORMATION
Name TOYIB AZIB MAULANA JAYA

ID Number (KTP) 3209150107030127

Address JL.PANGERAN KEJAKSAN NO.23 BLOK TUKSAJI RT/RW picture

01/03 KEL.BABAKAN KEC.SUMBER KAB.CIREBON

Telephone (1) 083837301137 Email

Telephone (2) 081311071829 maulanajaya010703@gmail.com
Place of birth CIREBON Date of birth (age) 01 JULI 2003 Religion ISLAM

Marital Status (single / Married / Widow) LAJANG Gender LAKI-LAKI

3.Education Information
Years
Institution name Bachelor or degree Location Field of study
completed

SDN 1 BABAKAN SEKOLAH DASAR 2009-2015

SEKOLAH MENENGAH
SMPN 2 SUMBER PERTAMA 2015-2018
SEKOLAH MENENGAH
SMK AL WASHLIYAH KEJURUAN 2018-2021

4.Family Information
Single
Name Age Last Education Occupation Company name
Father RASIDI 66 SD PETANI
IBU RUMAH
Mother KUSRINI 61 SD
TANGGA
IBU RUMAH
Child 1 RUSANAH 25 SMK
TANGGA
Child 2 ATIKAH 22 SMK RUMAH MAKAN
TOYIB AZIB FRESH
Child 3 18 SMK
MAULANA JAYA GRADUATE
Child 4

Married
Name Age Last Education Occupation Company name
Spouse (Husband / wife)
Child 1
Child 2
Child 3

5.Employment History
Reason for Work period
Employer name Address Salary Position title / duties
leaving Start End
Organization Chart Last Position
Please describe your last organization Chart including superior, colleague, and subordinate (if any)

6. Last Compensation & Benefit

Component Amount Remarks

Monthly Basic Salary

Income Tax
Transportation
Other AllowancesScheme
(please specify)
…………………
…………………
………………..
Total
OT Entitlement
Medical Scheme

7.Skills & Qualifications (Excellent, Good & Fair)

Others qualification such as special skills, abilities
BERMAIN ALAT MUSIK

Professionals licenses, certifications or registrations

SERTIFIKAT UJI KOMPETENSI

Additional skills, including supervision skills, other languages

BAHASA INDONESIA

Organizational experience
TARING PRING
Employee Organization / Union experience

8.References
List two personal references who are not relatives or former supervisors
Name Title / Occupation Company Telephone no. Years known

9.Others information
1. Have you had any serious illness, injury, or surgeon within last 2 years? Yes NO
No
2. Willing to placed on all area in HMC work area throughout indonesia Yes YES

No
3. Willing to travel for work Yes YES
No
4. Expected salary & benefit
salary :SAYA SUDAH MENGHITUNG BIAYA HIDUP SAYA DIDAERAH TERSEBUT, KISARAN GAJI YANG SAYA
BUTUHKAN SEKITAR 3 SAMPAI DENGAN 4 JUTA,TETAPI JIKA PERUSAHAAN KEBERATAN SAYA SIAP
MENGIKUTI STANDAR YANG DITENTUKAN OLEH PERUSAHAAN.

benefit :MENGEMBANGKAN POTENSI DIRI SEBAIK MUNGKIN DI PERUSAHAAN INI DAN SEKALIGUS MEMBERIKAN
YANG TERBAIK UNTUK PERUSAHAAN INI.

5. Have you ever been arrested, involvement in any dishonost or fraudulent, drugs and convicted of other crime acts? (YES / NO)
please explain if YES

NO

6. Do you have any acquaintance or family who had worked or currently working for this company ? (YES / NO)
please explain if YES - Name & Job position

NO
7. Availability to join (Date / Immediate)
SEGERA

10. Information to the applicant

1. I certify that all answers given herein are true and complete to the best of my knowledge YES
2. I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an YES
employment decision

3. In the even of employment, I understand that false or misleading information given in my application or interview(s) may YES
result in discharge

TOYIB AZIB MAULANA JAYA

_______________________ _______________________ ________________
Name of applicant Signature of Applicant Date