PT. ANDALAN TIGA BERJAYA PT.

ASMIN BARA BRONANG

PT. ASMIN BARA JAAN OTHER

POSITION APPLIED :

SEX :

M F

FULL NAME :
(match with ID Card)

Photo (3 x 4)

(FILLED BY HR DEPARTMENT) NIK : FIRST DATE OF WORKING : EMPLOYMENT STATUS : DEPARTMENT CODE : DIVISION :

POSITION : PERSONAL LEVEL : SPK No. : INA BANK A/C No : DATE OF RESIGNATION : PERMANENT ADDRESS : …………………………………………….. …………………………………………….. POST CODE : ………….. PHONE ………..…………….. CURRENT ADDRESS : …………………………………………….. ……………………………………………… POST CODE : ………….. PHONE ………..……………..

PLACE/DATE OF BIRTH : ………………………………………. HEIGHT :……… CM WEIGHT ……… KG ID NUMBER :……………………………………… PASSPORT NUMBER : ……………………………………… DRIVER LICENSE NO : ……………………………………… KPA NO. :……………………………………… JAMSOSTEK NO. : ………………………………………

MATERIAL STATUS :

SINGLE

MARRIED

DIVORCED BLOOD TYPE : ………………………

NATIONALITY : …………………………………

RELIGION : ……………………………..

EDUCATION : SCHOOL/UNIV. MASTER BACHELOR DIPLOMA SENIOR HIGH SCHOOL JUNIOR HIGH SCHOOL PRIMARY SCHOOL

NAME

ADDRESS

MAJOR/GPA FROM

TO

PASS/FAIL

STATE FOREIGN LANGUAGES YOU MASTER AND FILL IN YOUR LEVEL OF LANGUAGE MASTERY. LANGUAGE READING LISTENING SPEAKING 1 2 3

WRITING

REFERENCES : NAME 1 2 COMPANY ADDRESS/PHONE LIST OF ACHIEVEMENTS. ORGANIZATION HOBBIES AND ACTIVITIES FAMILY RELATIONSHIP. RELATION NAME SEX (M/F) DATE OF BIRTH (AGE) HIGHEST EDUCATION OCCUPATION POSITION COMPANY FATHER MOTHER BROTHERS/SISTERS (INCLUDING YOURSELF) 1 2 3 4 5 6 SPOUSE CHILDREN 1 2 3 TRAINING/COURSES NAME OF TRAINING INSTITUTION VENUES DURATION FROM UNTIL FINANCED BY 1 2 3 .

1.4 5 6 7 8 9 EMPLOYMENT HISTORY : STATE YOUR EMPLOYMENT HISTORY AS COMPLETELY AND ACCURATELY AS POSSIBLE BEGINNING FROM THE PRESENT OR LAST EMPLOYMENT TO PREVIOUS ONES. SERVICE YEARS YEARS MONTH FROM TO TYPE OF BUSINESS : LINE SUPERIOR : JOB DESCRIPTION OR DESCRIBE DUTIES AND RESPONSIBILITIES IN YOUR CURRENT/LAST POSITION : TOTAL EMPLOYEES : DIRECTOR : DESCRIBE THE ORGANIZATION STUCTURE SHOWING YOUR POSITION: NAMES/ADDRESS/PHONE OF COMPANY POSITION WORKING FIELD 2. SERVICE YEARS YEARS MONTH FROM TO TYPE OF BUSINESS : LINE SUPERIOR : NAMES/ADDRESS/PHONE OF COMPANY POSITION WORKING FIELD TOTAL EMPLOYEES : DIRECTOR : DESCRIBE THE ORGANIZATION STUCTURE SHOWING YOUR POSITION: JOB DESCRIPTION OR DESCRIBE DUTIES AND RESPONSIBILITIES IN YOUR CURRENT/LAST POSITION : .

3. SERVICE YEARS YEARS MONTH FROM TO TYPE OF BUSINESS : LINE SUPERIOR : NAMES/ADDRESS/PHONE OF COMPANY POSITION WORKING FIELD TOTAL EMPLOYEES : DIRECTOR : DESCRIBE THE ORGANIZATION STUCTURE SHOWING YOUR POSITION: JOB DESCRIPTION OR DESCRIBE DUTIES AND RESPONSIBILITIES IN YOUR CURRENT/LAST POSITION : 4. SERVICE YEARS YEARS MONTH FROM TO TYPE OF BUSINESS : LINE SUPERIOR : NAMES/ADDRESS/PHONE OF COMPANY POSITION WORKING FIELD TOTAL EMPLOYEES : DIRECTOR : DESCRIBE THE ORGANIZATION STUCTURE SHOWING YOUR POSITION: JOB DESCRIPTION OR DESCRIBE DUTIES AND RESPONSIBILITIES IN YOUR CURRENT/LAST POSITION : .

WHERE AND FOR WHAT PURPOSE ? HAVE YOU EVER BEEN INVOLVED IN ANY ADMINISTRATIVE. ( ……………………………………….PUT AN "√" IN THE CORRECT RESPONSE BOX HAVE YOU PREVIOUSLY APPLIED TO OUR COMPANY/GROUP ? IF SO WHEN AND WHAT POSITION ? ARE YOU ALSO APPLYING TO OTHER COMPANIES ? IF YES PLEASE MENTION WHAT COMPANIES AND POSITION APPLIED? ARE YOU UNDER CONTRACT AGREEMENT WITH OTHER COMPANIES ? DO YOU HAVE ANY OBJECTIONS IF WE CONTACT YOUR PREVIOUS EMPLOYER FOR HAD IT ? DO YOU HAVE ANY ACQUAINTANCE (S) OR RELATIVE (S) EMPLOYED BY. ANY MISREPRESENTATION OR OMISSION OF INFORMATION IS FOUND.) APPLICANT .20 ………. CIVIL OR CRIMINAL CASES ? IF ACCEPTED . WHEN CAN YOU START WORKING ? HEREBY CERTIFY THAT THE INFORMATION GIVEN ABOVE IS TRUE AND IF UNDER ANY CIRCUMSTANCES. …………………………………. WHEN.. DO YOU AGREE TO BE LOCATED ANYWHERE IN INDONESIA ? PLEASE MENTION THE PREFERRED CITIES OR REGIONS ! DESCRIBE ANY KIND OF JOBS THAT ARE IN LINE WITH YOUR CAREER PLAN ! PLEASE STATE YOUR CURRENT MONTHLY INCOME AND FACILITIES ? DESCRIBE ANY KIND OF JOBS THAT YOU DON'T LIKE ? STATE SALARY AND FACILITIES DESIRED ! IF ACCEPTED. OUR COMPANY/GROUP ? PLEASE MENTION NAME AND YOUR RWLATIONSHIP ? YES NO REMARKS WHAT SERIOUS ILLNESS/SURGERIES/ACCIDENTS HAVE YOU EVER HAD ? WHEN HAVE YOU HAD IT ? HAVE YOU EVER UNDERGONE ANY PSYCHOLOGICAL TEST BEFORE ? IF SO. I UNDERSTAND THAT I SHALL BE HELD RESPONSIBLE.