FM.03.

HCD

EMPLOYMENT
APPLICATION FORM

Date: Position you applying for:

A. PERSONAL INFORMATION
Full name :

Place & Date of Birth :

Religion :

Nationality : Marital status :

Height : cm, Weight : Kg

Home Address :

Phone : HP :

Email :

Emergency Contact :

B. FAMILY
1. Direct Family
Occupation –
Name Age Company Name Education Telp No.
Father
Mother
Husband/Wife
Children No.1
Children No.2
Children No.3

2. Siblings: Brothers/Sisters

No. Name Age M/F Telp No. Email Address

1
2
3
4
5
6

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8
9
10

Please answer this below question

 Why do you apply for this position/reply to the advertisement?

 Do you have any bonding agreement with your current company?
If yes, please explain

 Please inform your availability to join with Carsurin

 How would you describe yourself?

 Please describe your 3 strengths and 3 weakness

Strength Weakness
1. 1.
2. 2.
3. 3.

 Criminal Convictions

 Do you have any criminal record? Yes [ ] No [ ]

 If yes, please describe:

See this picture carefully, focus on the nose! Which part is more dominance, women or the man?

C. EDUCATION, WORKSHOP, TRAINING

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1. Education
EDUCATION Name & Place
Dates Remarks
Education Institute

2. Training
TRAINING Name & Place
Dates Remarks
Education Institute

3. Please provide at least 2 professional references from your previous job.

Company Name Title Phone HP

If you need additional space please write on the back of this form.

4. What languages do you speak and are proficient in?

Language Speaking Listening Writing

Remarks
Please use the following abbreviation above
VG: Very Good G: Good F: Fair P: Poor

D. WORKING EXPERIENCE

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Dates
Title Company Name Reason for Leaving
(From-To)

EMPLOYMENT DETAILS

Date of Employment : Date Employment Ended :

Company
Company Address
Business Line
Latest Position
Report directly
(Name/Position)
Number of Sub-Ordinates
Job Description 







Achievement 


How did you get employed
Reason for leaving
Last Drawn Salary

ORGANIZATION STRUCTURE

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*) Please draw your position within current/latest organization (including two levels up & below)

Date of Employment : Date Employment Ended :

Company
Company Address
Business Line
Latest Position
Report directly
(Name/Position)
Number of Sub-Ordinates
Job Description 







Achievement 


How did you get employed
Reason for leaving
Last Drawn Salary

Date of Employment : Date Employment Ended :

Company
Company Address

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Business Line
Latest Position
Report directly
(Name/Position)
Number of Sub-Ordinates
Job Description 







Achievement 


How did you get employed
Reason for leaving
Last Drawn Salary

E. COMPENSATION & BENEFIT DETAIL

No. Detail Compensation & Benefit Current Remark

1. Salary Nett/Gross (monthly)
2. THR
3. Incentive Bonus
4. Allowance
a.
b.
c.
d.
e.
5. Car Ownership Program
6. House Ownership Program

What is your expected salary?____________________________

F. ABOUT PT. CARSURIN

1. What do you know about Carsurin?____________________________________________

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2. Are you willing to place in any Carsurin Branches?

3. Do you know anybody working for Carsurin?

If yes, who is he/she?

4. Are you open for other position you are applying for?

“What is your passion in life?”

What is the 3 most important thing in your life?

I confirm that the information in this application form is true and honest.

Jakarta ...........................

_________________
Applicant

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