Employee Application Form

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The following information will help us 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 : ____________________________________________

Salary Expectation : ____________________________________________
Notice Period : ____________________________________________

PERSONAL DATA

Full Name : Date of Birth :

Address :

City : Post Code :

Telephone :

Email :

Marital Status : Religion :

Height / Weight :

FORMAL EDUCATION

Year of
University/School Major Academic Degree
Graduation

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 Employee Application Form

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 Employee Application Form
RECORD OF PREVIOUS EMPLOYMENTS
1. Company Name :
______________________________________________________
Industry : ______________________________________________________
Position : ______________________________________________________
Period : From ___________________ To __________________________
Supervisor’s Name : ______________________________________________________
Last salary : Rp ___________________________________________________
Reason for leaving : ______________________________________________________

2. Company Name :
______________________________________________________
Industry : ______________________________________________________
Position : ______________________________________________________
Period : From ___________________ To __________________________
Supervisor’s Name : ______________________________________________________
Last salary : Rp ___________________________________________________
Reason for leaving : ______________________________________________________

REFERENCES (Non – Relatives)

1. Name :_______________________ Mobile Number :______________________
Occupation :_______________________
Email Address : ____________________________________________________________

2. Name :_______________________ Mobile Number :______________________

Occupation :_______________________
Email Address : ____________________________________________________________

3. Name :_______________________ Mobile Number :______________________

Occupation :_______________________
Email Address : ____________________________________________________________

4. Name :_______________________ Mobile Number :______________________

Occupation :_______________________
Email Address : ____________________________________________________________

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 Employee Application Form

GENERAL INFORMATION
Are you presently employed ? YES ❑ NO ❑

Can we contact your present employer for a reference ? YES ❑ NO ❑

Do you have any health limitations/illnesses? YES ❑ NO ❑ If yes, please fill out the table below.

HEALTH RECORDS
LIMITATION/ILLNESS HOSPITALIZATION REMARKS
YES NO

DECLARATION
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

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