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CANDIDATE INTERVIEW FORM

1. Date 28 November 2022 2. Position Applied System Support

I PERSONAL INFORMATION AND PREFERENCES

3. Full Name Samuel Panuturi Silaban

4. Date and Place of birth Garoga, 30 Desember 2001

5. Sex Male Female

6. Marital Status (if single skip to
Single Married Divorce
number 8)
7. Number of children

8. Main Mode of Transportation Public Transport Car Motorbike Others

Desa. Dolok Margu, Kec. Lintongnihuta, Kab. Humbang Hasundutan, Prov.

9. Home Address
Sumatera Utara

10. Phone Number Home: - Mobile: 082228909192

11. Another way to contact you
12. When is the most ideal time to
call you by phone?
13. Email Address
Whatsapp: 082228909192
Skype:………………………………..
BBM: :………………………………..
GTalk:………………………………..
Anytime Office hour only After office hour Others……………………..
samuelpanuturi@gmail.com

14. ID Card Number (KTP) 1202143012010003

15. Current employment (other
than “still studying” skip to number Employed Self employed Unemployed Still studying
17)
16. How long do you expect to be
3-6 months 6 months – 1 year More than a year
graduated?
17. Your ideal employment term Free lance Contract Part time Permanent
18. Are you willing to be a contract
Yes No
employee?

19. Are you willing to travel? Yes No

20. Are you willing to be stationed

Yes No
in BANDUNG or Other Cities?

21. Are willing to work in shift

Yes No
schedule

21. Where did you get information

Instagram Job Street Website Social Media Others : Kampus
about this job opening?

Candidate Interview Form PT. Inova Medika Solusindo

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II EDUCATIONAL BACKGROUND
Formal
School/ University Major Degree Place Year
SD Negeri 173233 Garoga SD Sederajat Garoga 2007-2013
SMP Negeri 1 Garoga SMP Sederajat Garoga 2013-2016
SMA Neger 3 Tarutung SMA Sederajat Tarutung 2016-2019
ACADEMY

Institut Teknologi Del Diploma 3 Teknologi Informasi Laguboti 2019-2022

Judul Skripsi: Analisis Metode Regresi Linear Berganda untuk Memprediksi Hasil Panen Padi
IPK : 2,67
Non Formal/ Training/ Course
1. Analisis Data Eksplorasi dengan Seaborn
2. Managing Machine Learning Projects with Google Cloud
3. Webinar Enterprise Architecture
4. Webinar Pelatihan Perpustakaan Digital IT Del
5.

III SKILLS

Language
Oral 1 2 3 4 5
21. Indonesia
Written 1 2 3 4 5

Oral 1 2 3 4 5
22. English
Written 1 2 3 4 5

Oral 1 2 3 4 5
23. Other:…………………..
Written 1 2 3 4 5
Computer Skills
24. Operating System/Tools Linux Ubuntu 1 2 3 4 5

Windows 7 1 2 3 4 5

Office Tools 1 2 3 4 5

Mac 1 2 3 4 5
Git (Source Code Manajemen) 1 2 3 4 5

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Eclipse 1 2 3 4 5

Netbean 1 2 3 4 5
Other: Cisco Packet Tracer, Jupyter
1 2 3 4 5
Notebook
Photoshop 1 2 3 4 5

25. Multimedia CorelDraw 1 2 3 4 5

Other: Figma, Canva 1 2 3 4 5

HTML 5 1 2 3 4 5
CSS3 1 2 3 4 5
Jquery 1 2 3 4 5
CMS 1 2 3 4 5
26. Web Development
Ajax 1 2 3 4 5
Json 1 2 3 4 5
Javascript 1 2 3 4 5

Other: Boostrap 1 2 3 4 5

PostgreSQL 1 2 3 4 5

SQL Server 1 2 3 4 5

MySQL 1 2 3 4 5
27. Database & Reporting
Oracle 1 2 3 4 5

Reporting Service 1 2 3 4 5

Other:……………………………………………. 1 2 3 4 5

PHP 1 2 3 4 5

Java 1 2 3 4 5

C# 1 2 3 4 5

Framework YII 1 2 3 4 5
28. Programming Language
C 1 2 3 4 5

C++ 1 2  4 5

Dot NET 1 2 3 4 5

Other: Python 1 2 3 4 5
29. Hardware PC Setup 1 2 3 4 5
LAN 1 2 3 4 5

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WiFi 1 2 3 4 5
File/Print Server 1 2 3 4 5
Management Skills
Power Designer 1 2 3 4 5

Microsoft Project Management 1 2 3 4 5

Microsoft Office 1 2 3 4 5
30. Tools
Other: Trello 1 2 3 4 5

Other: SPSS 1 2 3 4 5

Other: Bizagi 1 2 3 4 5

NOTE: 5 is the highest while 1 is the lowest

IV EMPLOYMENT HISTORY

31.
Company Name PT Socfin Indonesia Position Quality Assurance
From-to Juni 2022 – Agustus 2020 Salary -
Menguji Aplikasi Gawai Pendataan Buah Kelapa Sawit
Menambah Fitur guest Sistem Informasi LibraryConservation

Job Description

Likes Lingkungan karyawan ramah Dislikes -

32.
Company Name Institut Teknologi Del Position Asisten Dosen
From-to Tahun ajaran 2021 Salary Rp. 400.000’-
Membantu Dosen dalam mengajari mahasiswa dalam matakuliah Matematika Diskrit

Job Description

Dapat mengingat kembali materi

Likes yang lewat., dan belajar bersama Dislikes
mahasiswa

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33.
Company Name Position
From-to Salary

Job Description

Likes Dislikes

V ADDITIONAL QUESTIONS

Saya mempunyai kemampuan interpersonal yang baik, saya dapat bergaul bersama semua
34. Your
rekan kerja dengan baik, disisi lain saya juga jujur apa adanya tidak malu bertanya jika saya
Strengths
tidak memahami sebuah tugas, dan itu dapat membuat saya belajar hal yang baru.

Saya belum memiliki banyak pengalaman kerja karena saya merupakan lulusan baru yang hanya
35. Your
mempunyai pengalaman saat magang. Dilain sisi saya memiliki jiwa yang perfeksionis dimana
Weaknesses
hanya untuk menyelesaikan kerja saya perlu mengecek ulang se-detail mungkin

36. Riwayat
Penyakit & Tidak Ada
Kecelakaan

37. Reference Name : Anita Siagian Name : Gaus Silaban

(List 2 Company : Mitra Integrasi Informasi Company : PT. STTC Siantar
person/superior to
Position : QA Position :Staff PLC
be your reference)
Phone Number : 0822-4935-2965 Phone Number : 0821-6606-4422
38. Expected Rp. 5.000.000 – 6.000.000 Negotiable Non-Negotiable
Salary
39. Availability Immediately 1 month notice Other:…………………..

40. Candidate’s Signature 41. Interviewer’s Name Samuel Panuturi Silaban

Candidate Interview Form PT. Inova Medika Solusindo