l<NOY N1\'rANAE L A RIOW,IN

AT T ORNEYS AT LAW

~ighty Eight@ Kasablanka, 9th floor, unit B, ANRLAWFIRM

JI. Casablanca Raya Kav. 88
Jakarta, 12870
INDONESIA
Phone : +62 21 2956 8495, 2956 8496
Fax : +62 21 29568497
www.anr-lawfirm.com

DATE : (MM,DD,YYYY)

Male/Female Religion
-6ttffl«ffle -Ant MiddRI
APPLICANT'S
COMPLETE NAME :
'' ' MAl'2- \.SL.Ar--"

Nationality Date of Marriage : (MM,DD,YYYY)

Place & Date of Birth:
(MM,DD,YYYY) ...
\~'90~'p\A
\ 5 /05 I \<3~r
Expected Salary:
Description of Position Wanted Present Salary:
,0 .000.000 \01( - 1.:U)OO ,ouJ ,o~
• Litigation Associate
• Corporate Associate
Why do you like to be employed by our firm?

\ Sll ~ \S o ~'\)CYttQfli\j o-s a wo~ -\"O com:1i~( kQ o.Y) fc,.tt-l'flO'llnj Olld , con cb c.v,th IYlj
Q..l(Oe(tt\"t ano c,c."9<!.l'lC/) (.C

EDUCATIONAL BACKGROUND
(Please start with High school and then continue with Academy and/or University & Speci al Course)
Date of Degree or
Course of Study Date Starting
Name & Place of School Completion/Discontinuation Diploma
(MM,DD,YYYYl
,we,un .;tOl b 1\0(:,US 1 P..0:10
QIPO t-iH,0"-0 tJ OI\I .
c9-o n ~_ol,l
5 $}\5 ~MA(lA\.lC

Speak Write
Read Understand
LANGUAGES:
(Mark v.1th x Fair Poor
Fair Poor Good Fair Poor Good
which is Good Fair Poor Good
applicable)
' '
,.J
.J ..J
Indonesian J
J J
English
Others
 f \ ha~t \~udul i+ in mj cJ
/\NOY NA l'ANAEI. & RIOW,'IN
ATTORNEYS AT LAW
v I

WORKING EXPERIENCE Monthly Salary

r Reason why you left
Name and Description of (or intend to leave)
From To
address of former Position
(MM,DD,YYYY) (MM,DD,YYYY)
employer (Office,
Company or
Person)

LIST 3 (THREE) PERSONS OF GOOD STANDING (NOT RELATIVE) WHO CAN PROVIDE
US WITH REFRENCE T Address
Years Known
His/her Occupation Aae fr\· '7 r-J l?N'-' I\1.10)
Name of the person
~Ob Hc.rl-l11 \ T
1 a 10FM1--t.k
!J -M· t'\OJ.c,~1(1.\ If T, (7/-)flJK HfliVOlitl
I
W{AoJAI \'{, .

I
PERSON TO BE CONTACTED IN CASE OF EMERGENCY I
Name of the person I Business Address I Home Address I Telephone No. I
I I I

FAM1LYDATA
l1
r Mother
Father
Parents t-1 Aflb~«1,1-vr
R~). rift () (<A t,.1A\f'1 I"\ 4
Name J~\\A{lil-t
Place/Date of Birth JA-\'\ A€l'\A'
01?DtJe©!ZO Ul-..ll v
Education bRQtJ\b~t-J LJtJ\\l.
Occupation :31-, reo~r f<f\'<1-
~7~. 't\;n~, <?ft.<-IPr
!

Address , '
Brother/Sisters (including you) Education ,Occupation
Age r Male/Female
Name
1.
2.
3.
4. I
I

5.
I hereby affirm that the information on this application form is true and completed and I
have not withheld any information, which would adversely affect my application. I
understand that I will be subject to disqualification or immediate dismissal if this
statement is false.