Employee Application Form

The following information will help us to assess your employment opportunity with Archipelago International
(hereinafter called the “Employer”). All portions of this application pertaining to you must be completed. We
appreciate the time you spend completing this application form.

Position applied :
Recent
____________________________________________
Second position applied :
Photo
____________________________________________
Salary Range Expectation :
____________________________________________
Notice Period : ____________________________________________

PERSONAL DATA
Full Name : Date of Birth :

Address :

City : Post Code :

Telephone (H) :

Telephone (M) :

ID Skype :

Email :

Facebook / Twitter :

I.D Card Number : Date of Expiry :

Marital Status : Religion :

Height / Weight : Blood Group :

EDUCATION AND TRAINING

Name and address of school,
Major Course or Decree of
University or other training From Date To Date
Study Certificate
institution

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 Employee Application Form

RECORD OF PREVIOUS EMPLOYMENTS

1. Company Name : ______________________________________________________
Position : _____________________________________________________
Period : From ___________________ To __________________________
Address : ______________________________________________________
Telephone : ______________________________________________________
Nature of Business : ______________________________________________________
Supervisor’s Name : ______________________________________________________
Duties : ______________________________________________________
Last salary : Rp ___________________________________________________
Reason for leaving : ______________________________________________________

2. Company Name : ______________________________________________________

Position : ______________________________________________________
Period : From ___________________ To __________________________
Address : ______________________________________________________
Telephone : ______________________________________________________
Nature of Business : ______________________________________________________
Supervisor’s Name : ______________________________________________________
Duties : ______________________________________________________
Last salary : Rp ___________________________________________________
Reason for leaving : ______________________________________________________

3. Company Name : ______________________________________________________

Position : ______________________________________________________
Period : From ___________________ To __________________________
Address : ______________________________________________________
Telephone : ______________________________________________________
Nature of Business : ______________________________________________________
Supervisor’s Name : ______________________________________________________
Duties : ______________________________________________________
Last salary : Rp ___________________________________________________
Reason for leaving : ______________________________________________________

REFERENCES (Non – Relatives)

1. Name :____________________Mobile Number :______________________
Occupation :____________________Years known :______________________
Address / Email : ____________________________________________________________

2. Name :____________________Mobile Number :______________________

Occupation :____________________Years known :______________________
Address / Email : ____________________________________________________________

3. Name :____________________Mobile Number :______________________

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 Employee Application Form

Occupation :____________________Years known :______________________

Address / Email : ____________________________________________________________

4. Name :____________________Mobile Number :______________________

Occupation :____________________Years known :______________________
Address / Email : ____________________________________________________________
LANGUAGE PROFICIENCY ( Language Spoken)
Speaking Reading Writing
Language
Poor Good Excellent Poor Good Excellent Poor Good Excellent
English
Mandarin
…..
…..

FAMILY RECORD
Father’s Name : __________________ Age : _______ Occupation : ___________________________
Mother’s Name : __________________ Age : _______ Occupation : ___________________________
Permanent Address : ____________________________________________ City:__________________
Telephone : __________________________________________________________________
Husband / Wife’s Name : ___________________Date of Birth: __________Occupation:_________________
Children :
1. Name : _______________________ Date of Birth : ________Male_______Female __________
2. Name : _______________________ Date of Birth : ________Male_______Female __________
3. Name : _______________________ Date of Birth : ________Male_______Female __________

GENERAL INFORMATION
Are you presently employed ? _______________________Yes ______________No ___________________
Have you ever been discharged from employment ? If yes, Please explain ___________________________
Can we contact your present employer for a reference ? _______________________Yes ______ No _____

Have you ever suffered from any of the following illnesses

ILLNESSES Yes No ILLNESSES Yes No
Tuberculosis Hepatitis
Heart Disease HIV / AIDS
Hypertension Venereal Disease
Diabetes Serious Illnesses
Epilepsy Injuries or Operations in last 5 Years

Do you have any immediate family members (i.e. husband, wife, parents, child, brother, sister) working with
any of Archipelago Hotels ?Yes ______ No______ If yes, who and which unit ?
(1) ____________________________________________________________________________________
(2) ____________________________________________________________________________________
(3) ____________________________________________________________________________________

DECLARATION

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 Employee Application Form

I certify that all statements made on this application are true and complete to the best of my knowledge. I
understand that misrepresentation or omission when discovered, will subject me to discharge and I hereby
authorize any investigation relating to my work experience, education or reputation for the purpose of my
application for employment.

Applicant’s Signature ___________________________Date ___________________________________

(……………………………..)

INTERVIEW ASSESSMENT

CODE : 1.Poor 2. Average 3. Good 4. Excellent

1st 2nd 3rd

Subject Comment Comment Comment
Interview Interview Interview
Appearance / Grooming / Punctuality
(Does he/she dress well, arrive in time, etc)

Energy / Enthusiasm
(Body language, eye contact, Shake hand, etc)

Technical Skills / Job Knowledge

(Basic skills, base on CV experience, Knowledge)

Attention to Detail
(Clarify a things, bad habit, stress stressor, etc)

Speech / Language Skills

(Fluent, slurred speech, Systematic etc)

Problem Solving
(Case study, give situation, simulation, etc)

Leadership Experience
(Check CV to see Positions held)

Interviewer’s Name

Date

Overall Comment

For Human Resources Department Only

Name : __________________________________
Position : __________________________________
Starting Date : __________________________________
Level : __________________________________
 Basic Salary : __________________________________
 Transportation Allowance : __________________________________
 Housing Allowance : __________________________________
 Others : __________________________________
 Gross Salary : __________________________________

REFERENCE CHECKING

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 Employee Application Form

1. Name / Company : __________________________Date : __________Comment : _______________

2. Name / Company : __________________________Date : __________Comment : _______________
3. Name / Company : __________________________Date : __________Comment : _______________
4. Name / Company : __________________________Date : __________Comment : _______________

APPROVED FOR HIRE

Department Head: __________________________________Date : __________________________________
HR : __________________________________Date : __________________________________
Finance : __________________________________Date : __________________________________
GM : __________________________________Date : __________________________________

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