Employee Application Form

A. DATA PRIBADI
(Personal Data)

1 Nama Lengkap Sesuai KTP Jenis kelamin / Sex √ Pria / Male

Reza Ary Fachrurrozi
(Full Name According to ID) Wanita / Female

2 Nama Panggilan Golongan darah

Reza O
(Nick name) Blood type

3 Tempat & Tanggal Lahir

Metro, 04 Januari 1995
(Place & Birth date)
(Photo)
4 Kewarganegaraan
Indonesia
(Citizenship)

5 No. KTP
1807220401950003
(ID Number)

6 No Paspor
(Passport Number)

7 Alamat sesuai KTP

Dusun IV Margasuka 2 Braja Indah, Kec. Braja Selebah, Kab. Lampung Timur, Lampung
(Address according to ID)

8 Alamat saat ini

Komplek Bumi Panyileukan Blok G1 No. 5 Kel. Cipadul Kidul, Kec. Panyileukan, Kota Bandung
(Current Address)

9 Status tempat tinggal saat ini Pribadi √ Kost Asrama Lainnya

(Current residential status) (Private) (Boarding house) (Dormitory) (Others)

10 Agama √ Islam Kristen Protestan Katolik Buddha Hindu Konghucu

(Religion) (Islam) (Christian) (Catholic) (Buddha) Hindu) (Konghucu)

11 Status Pernikahan √ Belum menikah Sudah Menikah Janda / Duda

(Marital Status) (Single) (Married) (Widow / Widower)

12 Nomor NPWP 14 No. Handphone

94.845.430.1-321.000 085217516462
(Taxpayer Registration Number) Mobile phone number)

13 Nomor Kartu Keluarga 15 Alamat email

1807222001100040 rezaaryf@gmail.com
(Family Registration Number) (Email Address)

14 Surat Izin Mengemudi Tipe / Category C √ ya / yes No. SIM

950125340600
(Driving License) Tidak / no (Driving License Number)

Tipe / Category A √ ya / yes No. SIM

1344-9501-000025
Tidak / no (Driving License Number)

15 Kendaraan yang Digunakan Mobil Pribadi / Private

(Vehicle own used) (Car) Orang tua / Parents
Lainnya / Others

√ Sepeda Motor √ Pribadi / Private

(Motorcycle) Orang tua / Parents
Lainnya / Others

Kendaraan umum
(Public transport)

16 Hirarki Keluarga (Termasuk Diri Sendiri)

Family Hierarchy (Including Yourself)
Sex Alive
Name Date of Birth Education Job / Position
(M/F) (Yes / No)
Father Bambang Yuswanto M 9/29/1971 Yes Strata 1 Pegawai Negeri Sipil (PNS)
Mother Sudarmi F 1/15/1968 Yes Strata 1 Pegawai Negeri Sipil (PNS)
1
2
3
4
5

Suami / Istri
(Husband / Wife)

Anak / Children
1
2
3
4
B. KEMAMPUAN & PENDIDIKAN
(SKILL & EDUCATION)

1. Latar Belakang Pendidikan

(Educational Background)
Education Level Institution Name City/ Country Period Faculty Certified
Y/N
Elementary Shool SD Islam Terpadu Baitul Muslim Way Jepara, lampung -
Junior High School SMP Islam Terpadu Baitul Muslim Way Jepara, lampung -
Senior High School SMA Negeri 1 Way Jepara Way Jepara, lampung -
Diploma / College - Major: Minor:
Bachelor Degree Universitas Negeri Jambi (S1)/Universitas Bhakti Kencana Jambi/Bandung - Major: Minor:
Bandung (Apoteker)
Master Degree - Major: Minor:
Doctoral Degree -

2. Kursus, Workshop, & Pelatihan / Pendidikan Non Formal

(Courses, Workshops, & Trainings / Non-Formal Education)
Title Duration Year Organizer Certified
Y/N

3 Prestasi akademik yang anda capai selama masa pendidikan (mis: IPK cumlaude / menjadi pengurus di organisasi kampus, lulus dengan penghargaan, menjadi juara dalam event ilmiah, dll)
(Academic achievement you obtained within your education years (e.g. be outstanding, graduated with honour, be the best in scientific events, etc)

4 Karya Tulis Ilmiah yang Telah Anda Tulis (thesis, artikel, buku, dll)
(Scientific paper you have written (thesis, articles, books, etc)

4. Bahasa Asing dan Asli yang Dikuasai

(Foreign and native language mastered)
Speaking Writing Reading
Language
Poor Fair Good Excellent Poor Fair Good Excellent Poor Fair Good Excellent

5 Pengetahuan / kemampuan teknis yang dikuasai

(Suppurting technical skill / knowledge)
Technical skill / knowledge Poor Fair Good Excelent

6 Keanggotaan dalam organisasi kemahasiswaan

(Membership on student organization)
Period
Student Organization Position Remarks
(year)

6 Partisipasi dalam organisasi sosial / agama / kemasyarakatan

(Membership on student organization)
Period
Social / Religion Organization Position Remarks
(year)

6 Partisipasi dalam organisasi profesi

(Membership on professional organization)
Professional Organization Period Position Remarks
(year)
C. PENGALAMAN KERJA
(WORK EXPERIENCES)

1. RIWAYAT PEKERJAAN (Dimulai dari Perusahaan Terakhir)

(JOB HISTORY starting from latest company)
Company Name : CV. PASMA
Bussiness Field : Distributor Frozen Food
Total Work Period :
Stating Position : Latest Position :
Work Period : Work Period :
Starting Salary : latest Salary :
Job Description: Job Description:
- -
- -
- -
- -
- -

Draw your starting position in organization structure: Draw your latest position in organization structure:

Resignation Motive : sudah lulus dr kuliah dan mencari tantangan baru di perusahaan lain

Company Name :
Bussiness Field :
Total Work Period :
Stating Position : Latest Position :
Work Period : Work Period :
Starting Salary : latest Salary :
Job Description: Job Description:
- -
- -
- -
- -
- -

Draw your starting position in organization structure: Draw your latest position in organization structure:

Resignation Motive :

Company Name :
Bussiness Field :
Total Work Period :
Stating Position : Latest Position :
Work Period : Work Period :
Starting Salary : latest Salary :
Job Description: Job Description:
- -
- -
- -
- -
- -

Draw your starting position in organization structure: Draw your latest position in organization structure:

Resignation Motive :

2. Prestasi Luar Biasa yang Anda Capai Selama Bekerja

(Outstanding Achievement you Obtained During your Working Periods)
a.
b.
c.
E. TOPIK YANG BERKAITAN DENGAN LAMARAN PEKERJAAN
(TOPICS RELATED WITH JOB APPLICATION)

1. Posisi yang Diharapkan

(Expected Job Position )

2. Lingkungan Kerja yang Diharapkan Kantor Area penjualan √ Pabrik Laboratorium

(Working Environment Preferred) (Office) (Sales Field) (Plant) (Laboratory)

3. Bidang apa saja yang menjadi minat Anda (Mohon diberikan ranking dari yang paling Anda minati ke yang paling kurang Anda minati)
(Which area do you interest more? (Please put ranking from the post you most desired up to less desired)

PPIC Pengembangan Bisnis Pengendali Mutu Sumber Daya Manusia

(PPIC) (Business Development) (Quality Control) (Human Resource Development )

Pembelian Pemasaran dan Komersialisasi Medik dan Ilmiah Hukum

(Purchasing) (Marketing & Commercialization) (Medical & Scientific) (Legal)

√ Produksi Keuangan / Akuntansi / Audit Pengembangan Klinik Personalia & Umum

(Production) (Finance / Accounting / Audit) (Clinical Development) (Personnel & General Affair)

Teknik dan Pemeliharaan Teknologi dan Informasi Penelitian dan Pengembangan Dukungan & Administrasi
(Technic & Maintenance) (Information Technology) (Research & Development) (Support / Administration)

4. Apakah Anda bersedia melakukan perjalanan dinas keluar kota / keluar negeri? √ Ya / Yes Tidak / No
(Are you willing to walk on Out of Town/Country Duty ?)

05. Apakah Anda bersedia ditempatkan di luar kota / luar negeri? √ Ya / Yes Tidak / No
(Are you willing to be stationed out of town / country ?)

6. Apakah Anda bersedia menjalankan Masa Percobaan ? √ Ya / Yes Tidak / No

(Are you willing to Perform 3 Months Probation Period ?)

4. Jika anda berhasil lolos seleksi, seberapa cepat anda dapat bergabung ?
Sehari setelah diterima
(If you pass all the selection process, how soon can you join ?)

5. Apakah ada kenalan atau kerabat anda yang bekerja di PT. Bifarma Adiluhung / Kalbe company ? Jika iya, silahkan mengisi kolom dibawah :
(Is there any of your acquaintance or family member who works in PT Bifarma Adiluhung / Kalbe company ? If yes, fill the column below)
Name Relationship Sex Company's Name Position Phone
(M/F)

6 Apakah ada kenalan atau anggota keluarga Anda yang bekerja di Perusahaan Farmasi (Non Perusahaan Kalbe) ? Jika iya, silahkan mengisi kolom dibawah :
(Is there any of your acquaintance or family member who works in Pharmaceutical Company (Non-Kalbe Company) ? If yes, fill the column below)
Name Relationship Sex Company's Name Position Phone
(M/F)

7 Tuliskan nomor kontak dari atasan anda sebagai refrensi kerja

(Please write down the contact number of your supervisor(s) for refrence check
Name Relationship Sex Company's Name Position Phone
(M/F)
F. KESEHATAN & KARAKTERISTIK PRIBADI
(HEALTH & PERSONALITY)

1. Apakah anda pernah mengalami cedera serius / kecelakaan ? Ya / Yes √ Tidak / No

(Have you ever been critically injured / accident ?)

Jika iya, jenis kecelakaan apa yang pernah anda alami? Kapan / When ?
(If yes, what kind of injured ?)

Apa efek dari kecelakaan tersebut ?

(What is the effect ?)

2. Apakah Anda pernah menderita penyakit serius ? Ya / Yes √ Tidak / No

(Have you ever been suffered by serious desease / illness ?)

Jika iya, apakah jenis penyakitnya ? Kapan / When ?

(If yes, what kind of desease ?)

Apa efek dari penyakit tersebut ?

(What is the effect ?)

3. Apakah anda bersedia menjalani pemeriksaan kesehatan? √ Ya / Yes Tidak / No

(Are you willing to perform medical check-up ?)

4. Sebutkan 3 kelebihan dan kekurangan anda dalam bekerja Kelebihan / Strength Kekurangan / Weakness
(Describe 3 of your strength and weakness )

5. Apakah anda bersedia menjalani psikotes? √ Ya / Yes Tidak / No

(Are you willing to perform psychological test ?)

DISCLAIMER
Saya menyatakan bahwa semua informasi yang saya berikan dalam formulir ini adalah benar dan akurat sejauh pengetahuan saya.
Saya juga bersedia diperiksakan status saya kepada lembaga lain oleh perusahaan.
Apabila ada informasi yang keliru, saya siap menerima sanksi yang berlaku sesuai dengan ketentuan perusahaan.

(I hereby acknowledge that all information I have filled in this form are true and accurate to the best of my knowledge.
I also willing to be checked regarding my status to other institutions by the company.
Should there be any false information, I'm willing to receive any sanctions according to company's regulation.)

Bandung, 30 November 2020

(apt. Reza Ary Fachrurrozi, S. Farm)

 APPLICANT COMPENSATION & BENEFIT FORM

A. Applicant Identiy
Name : Reza Ary Fachrurrozi
Position Applied : Production Scientist

B. Salary Detail on the last company

Basic Salary Gross
Nett

Transportation Allowance Yes If yes: Rp.

No

Meal Allowance Yes If yes: Catering

No Meal allowance Rp.

Medical Allowance Yes IF yes: Insurance

No Reimbursement

Religious Holiday Allowance Yes If yes:

No

Bonus Yes If yes:

No

Overtime Allowance Yes If yes: Rp.

No

Communication Allowance Yes If yes:

No

Vehicle Facility Yes If yes: Company Car

No Vehicle Allowance Rp.

Pension Fund Yes

No

Other Allowances Yes If yes:

No

TOTAL TAKE HOME PAY ON THE LATEST COMPANY :

Rp.
(Monthly)

C. Salary & Benefit Expectation

Take Home Pay per Month Expected ± Rp. 6000.000,00

(Monthly)

√ Negotiable Not Negotiable

Expected Benefit & Facility:

Meal Allowance
Medical Allowance
Overtime Allowance
Bonus