APPLICATION FORM

CONFIDENTIAL

Position Applied:

PERSONAL DATA

Full Name : Male/Female *

Place/ :
Birthdate

Hobbies :

Religion : Ethnic :
Group

Formal : Title :
Education

KTP No : Issued in :

Telp. No. : E – mail :

Address :

FAMILY

1. Marital Status Single Married

Engaged Divorced

2. Members of family ( Husband/Wife and Children )

If they have passed away, please mention their last education & job.
How many children do you have? _______

Family Name M/F Birthdate Education Job

Spouse

Child 1

Child 2

Child 3
 APPLICATION FORM
CONFIDENTIAL

3. Do you have other dependents besides your wife or children ?

4. House Status
Private owned Parent Owned Relative owned
Rent Contract Other .....................

EDUCATION

1. Formal Education (begin from Senior High School)

no Institution Name Major Place Fro To

m

a.

b.

c.

2. Have you ever failed in school ?______________How many times ?

______________
Why?
__________________________________________________________________
__________

3. Did you ever get any achievements in any field? If yes, please describe briefly.

4. Do you posses any computer skills? If yes, please describe briefly.

Courses Attended
no Topic Of Course Organizer Period
a.

b.

c.
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CONFIDENTIAL

6. Foreign Language

a. Speak * Read * Write *

b. Speak * Read * Write *

WORKING EXPERIENCE

1. Name of Company

Line of Business

Period of work (month- up to

year)

The last position

The job description

Reason for leaving

Salary

2. Name of Company

Line of Business

Period of work (month- up to

year)

The last position

The job description

Reason for leaving

Salary
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CONFIDENTIAL

3. Name of
Company

Line of Business

Period of work up to
(month-year)

The last position

The job
description

Reason for
leaving

Salary

REFERENCE
Name your references (not less than two, not in this company, nor your friend or family)
no Name Position Relationship Telp No.
1.

2.

REMUNERATION
Expetation salary :
Benefit :