FORM KELENGKAPAN DATA KARYAWAN

Nama
NIK
Posisi
Departemen

No. Item (√)

1 Form Isian Data Pelamar
2 Surat Lamaran Kerja
3 Curriculum Vitae
4 Pas Foto ukuran 3x4
5 Fotokopi KTP
6 Fotokopi NPWP
7 Fotokopi Kartu Keluarga
8 Fotokopi Surat Ijin Mengemudi/ SIM ( √ )
Sim A SIM B SIM C
9 Fotokopi Kartu BPJS Ketenagakerjaan / Jamsostek
10 Fotokopi Kartu BPJS Kesehatan
Fotokopi Ijasah dan Transkrip Nilai Pendidikan Terakhir
Ijasah ( √ ) Transkrip ( √ ) Ijasah ( √ ) Transkrip ( √ )
11 S2 SMA/SMK *
S1 SMP
D3 SD
12 Surat Keterangan Berbadan Sehat
13 Surat Keterangan Domisili RT s/d Kelurahan (bagi kost/ kontrak)
14 Fotocopy Rekening BCA yang masih aktif
a.
b.
c.
d.
e.
15 Dokumen Pendukung Lainnya
a.
b.
c.
d.
e.

* Semua dokumen diatas wajib dilengkapi

HRD/FRM/2019/XI/001/Ver 1.00 1 /8
 Recent Photo
(3x4)
CANDIDATE APPLICATION FORM
(Please fill with CAPITAL letter)

PERSONAL PROFILE

Full Name Messayu Ajeng Chandrakirana

Nick Name Messayu
Gender v Female
c Male | c )*

Body Height & Weight 160

_________ 70
Cm ___________Kg
Blood Type c O | c A | cv B | c AB )*
Birthplace & Date of Birth
Semarang, 06 Agustus 1993
Nationality v Indonesian | c Foreigner
c )*

Ethnic v Javanese | c Sundanese | c Chinese | c Others : __________________________

c Bataknese | c )*

Religion v Moslem | c Catholic | c Christian | c Others : ____________________

c Buddhist | c Hindu | c )*

Marital Status v Single | c Married | c Divorce

c
)*

Cellphone Number 085792321420

Phone Number 085792321420
E-mail ajengmessayu@gmail.com
NPWP Number 74.330.575.7-903.000
ID Card Number 5171024608930002
ID Card Address Perum Padang Pesona Graha
District : Denpasar Barat Province : Bali

Last Address Jl. Bintara Jaya VII RT. 09 RW. 09 No. 27 Kel. Bintara Jaya
District : Bekasi Barat Province : Jawa Barat

Ownership v Parents | c Relatives | c Rent | c Others : ____________________________

c Own | c Boarding | c )*
)* Please gives check sign (P)

FAMILY MEMBER

Relationship Complete Name Gender Birthplace, Date of Birth Education Phone Number

Father
Wahyu Trisunu A Male Palembang, 13-10-1954 Strata 1 0812-4669-7617
Mother Rochana Nugraheni Female Semarang, 16-12-1961 Strata 1 0812-3955-449
Yudhistira Anindhya Male Kudus, 06-08-1993 0857-9099-9317
Brother / Sister Strata 1
Brother / Sister Ayudhawara Indira Kusuma Female Semarang, 08-08-1985 Strata I 0812-3830-3988
Brother / Sister

NUCLEAR FAMILY
Relationship Full Name Gender Birthplace, Date of Birth Education Phone Number
Husband L
Wife P
Child

HRD/FRM/2019/XI/001/Ver 1.00 2 /8
 REFERENCE
(Please fill with superior level or HR name in latest company)

Name Department Relationship Phone Number

Sazha Busha Sazha Busha & Friends Team Leader 0878-6061-1006

Ayda Fayadd Summarecon Bali HRGA 0857-3867-5604

Dewi CV Angkasa Bali Lead Admin 0812-3739-2351

EDUCATION
Degree Institution City Major From Until Title GPA

Elementary School
SDN 2 Wergu Wetan Kudus 1999 2005
Junior High School SMP Dharma Praja Badung 2005 2008
Senior High School SMA 1 Saraswati Denpasar IPA 2008 2011
Diploma

Bachelor STIBA Saraswati Denpasar Sastra Inggris 2012 2017 S.S 2.85

Post Graduate

WORKING EXPERIENCE
(Starting from the latest company)

Starting Work Period 2021 Until Now

Company Name Amagi Holding Company - Surabaya
Position Marketing Manager
Bussiness Type F&B
Address & Phone Number Corica Building Lt. 5 Jl. Biliton No.40A, Gubeng, Kec. Gubeng, SURABAYA - Jawa Timur 60281

031 - 99441098
Supervisor Name Redo Maurent
Latest Salary 7.250.000
Allowance BPJS, Insentive
Exit Reason

Starting Work Period 2019 Until

2021
Company Name PT. Summarecon Agung, Tbk - Bali
Position Marketing Supervisor
Bussiness Type Retail and Hospitality
Address & Phone Number Jl. Wanagiri, Jimbaran, Kec. Kuta Sel., Kabupaten Badung, Bali 80364
(0361) 4468600

Supervisor Name ADITYA RANGGA

Latest Salary 5,400.000
Allowance BPJS, PARKING, INSETIVE

Exit Reason Career Development

HRD/FRM/2019/XI/001/Ver 1.00 3 /8
Starting Work Period 2018 Until 2019
Company Name PT. Natuna Pesona Mandiri - Bali
Position Sr. Marketing Communication
Bussiness Type F&B
Address & Phone Number Kantor Secret Garden Vilage - Sales & Matketing Office Komplek Pertokoan Tuban Plaza
Jl. By Pass Ngurah Rai no. 23, Kuta - Bali - 085792321420
Supervisor Name Ibu Ana
Latest Salary 4.500.000
Allowance BPJS, INSENTIVE
Exit Reason Career Development

Job Applied
| 1. Marketing Staff | or | 2.
Expected Salary
| Rp. 7,000,000 | until | Rp.

| 30 Days
Join Date

FOREIGN LANGUAGE PROFICIENCY

Level of Mastery
Foreign Language (Poor, Fair, Good, Excellent)
Speaking Listening Writing Reading

English Excellent Excellent Excellent Excellent

Excellent Excellent Excellent Excellent
Indonesian

EXPERTISE
Please gives check sign (P)

Type of Skills Beginner Intermediate Advance

1. Marketing And Event Planner v

2. Public Relation v
3. Microsoft Office v
4. Digital Marketing v
v
5. Business Relation
6. Social Media Management v
7.

OTHER INFORMATION
SOCIAL ACTIVITY / ORGANIZATION
(Including organization's name, position/level, active period, and location)

INTEREST / HOBBY
(Including organization's name, position/level, active period, and location)
Reading, Photography, Social Media

HEALTH
(Including organization's name, position/level, active period, and location)

HRD/FRM/2019/XI/001/Ver 1.00 4 /8
 OTHER QUESTION
Please circle which applied

1. Have you ever following psychological testing before? Yes / No

If yes, when and what is the purpose?

Yes, job application purpose

2. Are you willing to follow medical check up? Yes Yes / No

3. Are you willing to follow 3 month probation? Yes Yes / No

4. Are you willing to be placed in other city? No, Jakarta area only Yes / No

5. Do you know any employee in this company? If yes, who is it?

No

6. What is your relationship with those names?

No

ASPIRATION
(Including desire, hope, or ambition in life)

I’m really excited by this position at Veranda Hotels. I’d like to be seen as someone with deep expertise in the Marketing department.
and I know that’s something that I’ll have an opportunity to do here. I’m also really excited to take higher responsibilities in the next few
years and potentially even take the lead on some projects

PRINCIPLE / LIFE PHILOSOPHY

Life philosophy: Everything in life has some risk, either you will take it or leave it.
And for me, better take it then feel bad than nothing at all

STRENGHT AND WEAKNESS

S: Creative, Humble, Flexible, Initiative
W:Too details

HRD/FRM/2019/XI/001/Ver 1.00 5 /8
 Please draw a chart to explain your recent / latest position level in the organizational structure

CEO
|
GM
|
MARKETING MANAGER
|
E-COMMERCE - SOCIAL MEDIA TEAM - GRAPICH DESIGN - ADMIN

(Please write a short essay about your job description in your latest workplace)

As a marketing managers play a crucial role in helping a business to promote and sell its products to its customers.
1. managing the promotion and positioning my brand
2. Approving the content for Social Media
3. Create Event
4. Plan, strategy, and analysis

HRD/FRM/2019/XI/001/Ver 1.00 6 /8
 PERNYATAAN AUTENTIFIKASI INFORMASI
Saya menyatakan dan menjamin bahwa semua informasi di atas adalah benar dan saya tidak menyembunyikan fakta yang sesungguhnya.
Saya memberikan kewenangan kepada Pulauintan untuk menghubungi semua pihak yang bersangkutan untuk keperluan verifikasi dan
untuk mendapatkan informasi lainnya mengenai saya secara lisan maupun tertulis dari waktu ke waktu apabila hal itu dianggap perlu.
Apabila dikemudian hari ditemukan bahwa data yang saya sampaikan diatas tidak benar dan/atau ada pemalsian, maka saya bersedia
dihilangkan haknya sebagai karyawan Pulauintan dan dikenakan tuntutan perdata dan pidana sesuai ketentuan hukum dan perundang-
undangan yang berlaku.

10 Juni 2021
Jakarta, ____________________

Messayu Ajeng Chandrakira

________________________________

Nama lengkap

HRD/FRM/2019/XI/001/Ver 1.00 7 /8
 FORM KELENGKAPAN KARTU KARYAWAN
*diisi oleh HRD

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