PT APEXINDO PRATAMA

Gedung Office 8 la
Jl. Jend Sudirman K
HUMAN RESOU

POSITION APPLIED : SAFETY OFFICER DATE: AUGUST 21, 2018

APPLICATION FOR EMPLOYEMENT FORM

- The Content of this Form have no obligation for both parties
- This form should be completed in English

THE SOURCE OF INFORMATION FOR POSITION APPLIED (please choose)

1. Apexindo Website 4. On my own

2. Newspaper adv. 5. Apexindo Empoyee (please mention)
3. Friend/Relatives 6. Other (please mention)

PERSONAL DETAIL
FULL NAME : Mohd. Wirawan Putra Pamungkas
DATE OF BIRTH : April 26 1994
ID/PASSPORT NUMBER : 1.67E+15
ADDRESS : Komp. Sukarami Indah Blok B7 No 9 RT 07 RW 03 Kel. Kebun Bunga Kec. Sukarami
CITY : Palembang COUNTRY: Indonesia
CONTACT NUMBER : HOME :
EMAIL ADDRESS : mohd.wirawan@gmail.com
NATIONALITY : Indonesia
MARITAL STATUS : Single

FAMILY DETAILS
No. Family Relation M/F Name Place & DOB
1 Father M Sofyan Djamil Tebing Geriting, Juny 14 1952
2 Mother F Mariawati Palembang, February 27 1957
3 Spouse
4 Child/Sibling/Self M Mohd Wimpratama Rian Putra Palembang, 30 Desember 1988
5 Child/Sibling/Self F Widya Paranita Palembang. 16 Juli 1989
6 Self M Mohd Wirawan Putra Pamungkas Palembang, 26 April 1994
7 Child/Sibling/Self M Mohd Wikana Putra Prikas Palembang, 19 April 1995
8 Child/Sibling/Self

You are child number 3 from total children of 4

FORMAL EDUCATION
Years
No. School/ University Name Formal Education
No. School/ University Name Formal Education
From To
1 SMAN 13 PALEMBANG Sr. High School 2009 2012
2 POLTEK AKAMIGAS PALEMBANG Academy 2012 2015
3 UNIVERSITAS ISLAM RIAU University 2016 2018
4 Post Graduate
5

INFORMAL EDUCATION, TRAINING, COURSE, SEMINAR

No. Institution Name Location Sucject/ Topic Month & Year
1 Tritama Olah Profesindo Palembang Occupational Healthy and Safety Expert 15 Days
2 LBPP LIA PALEMBANG Palembang Conversation Class 2 years
3
4
5

FOREIGN LANGUAGES
No. Language Speaking
1 English Fair Good Excellent
2 Fair Good Excellent
3 Fair Good Excellent

No. Skill Name

1
2
3
4
5

GENERAL INFORMATION
No. Strenght(s) Weakness(es)
1
2
3
4
5

WORKING EXPERIENCES (START WITH CURRENT JOB, INCLUDING TEMPORARY WORK & VOCATIONAL TRAINING)

Name & Type of

Rig (Land Rig,
No. Company Name Position Rig Client W/O, Jack Up, Geothermal/
Location Oil Project
Semi, Tender)

1
 2

10

WORKING REFERENCES
No Name Company Name Location
1
2
3
4
5

GENERAL
Your expected salary on the position applied (Brutto / Nett)
Are you willing to relocate? Yes / No (if No please explain)
Are you willing to travel? Yes / No (if No please explain)
Have you been or are you suffering from any serious physical disability or disease?

I declare that the above mentioned statements are true and ready for any retribution if company found impropriate data.

)
(signature of applicant)
O PRATAMA DUTA TBK.
Gedung Office 8 lantai 20-21, SCBD Lot 28
Jl. Jend Sudirman Kav 52-53 Jakarta 12190
HUMAN RESOURCES DEPARTMENT

GUST 21, 2018

NICKNAME: Awan
PLACE : Palembang

ZIP CODE : 30152

MOBILE : 8.123E+10

ETHNIC:
RELIGION :Islam

Education Occupation
S2 Economy Management
Senior Hig Science

S1 Economy
S1 Economy
S1 Petroleum Engineer
D3 Navy Transportantion

Degree &
Major Graduate NEM / GPA
 Degree & Graduate NEM / GPA
Major
SCIENCE Yes/No
PETROLEU Yes/No 3.63
PETROLEU Yes/No 3.66
Yes/No
Yes/No

Date Of
Certifacate
Certified Certificate Attached
Validity
Yes/ No 15-Jul-15 Yes/No
Yes/ No 1/30/2016 Yes/No
Yes/ No Yes/No
Yes/ No Yes/No
Yes/ No Yes/No

Written
Fair Good Excellent
Fair Good Excellent
Fair Good Excellent

Level
Fair Good Excellent
Fair Good Excellent
Fair Good Excellent
Fair Good Excellent
Fair Good Excellent

Interest/ Hobby

NAL TRAINING)

Month & Years

Reason for
From To Leaving
 Position Title

Yes/No (if Yes please explain below)

ate data.