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EMPLOYEE APPLICATION FORM 3x4

PERSONAL INFORMATION
Position to applied Apply Date
Full name ID no. (KTP/SIM)
Place/Date of Birth Gender Religion
Marital Status Single Married Divorced Email
Telp No.
Home Address
HP No.
Telp No.
Current Address
HP No.
Motorcycle : Car : Public
Transportation
Type : Type : Transport :
Emergency Contact
Full name Relationship
Telp No.
Address
HP No.

Family Relationship Full Name Date of Birth Age Educational Level Employement
Father
Mother
Siblings 1
Siblings 2
Siblings 3
Siblings 4
Siblings 5
Husband / Wife
Children 1
Children 2
Children 3
Children 4

EDUCATION BACKGROUND
Years Completed
Level Education Institution Name City Graduate/Degree Major GPA
From To
High School
College
University
Master
Training/Workshop
Training/Workshop
Training/Workshop

Speaking Writting Computer Good Fair Poor

Language
Good Fair Poor Good Fair Poor Microsoft Excel
English Microsoft Word
Others: Microsoft Power Point
Others
EMPLOYEMENT HISTORY
Please list your work experience for the beginning with your most recent job held. If you were self-employed, give firm name.
Company name and address: Position title/duties, skills: Start date: End date:
Reason for leaving:

Pay : Rp.
Per : Supervisor: Phone: Expectation:
Company name and address: Position title/duties, skills: Start date: End date:
Reason for leaving:

Pay : Rp.
Per : Supervisor: Phone:
Company name and address: Position title/duties, skills: Start date: End date:
Reason for leaving:

Pay : Rp.
Per : Supervisor: Phone:
Company name and address: Position title/duties, skills: Start date: End date:
Reason for leaving:

Pay : Rp.
Per : Supervisor: Phone:

Please mentioned about your Social Media Account

Facebook
Twitter
Instagram
Youtube Channel
SKYPE ID

REFERENCES
List two personal references who are not relatives or former supervisors
Name: Address: Telephone: Positions: Years known

Job information I declare that all information given herein is true and correct. I
Jobstreet understand that any misrepresentation or omission of facts will
FB / IG / Twitter (*circle one) be sufficient cause for cancellation of consideration for
Broadcast Message employment or dismissal from the Company’s service if I have
Headhunter: ____________________________ been employed.
LinkedIn
Campus Hiring Jakarta, ________________________ 20______
Line Jobs
Reference From : ___________________________

(______________________________________)
*Full Name