Application Date: _______________

EMPLOYMENT APPLICATION FORM

(PLEASE USE CAPITAL LETTERS)

Post applied for:

I. PERSONAL DATA

A. Personal Details
Full Name : Sex: Male / Female
Place of Birth : Date of Birth: Religion:
Home Address: ID No: Ethnicity:
Home Phone: Marital Status:
Mobile Phone: Married
Pager: Single
Work Phone: Others

B. Family Details
Name Sex Age Education Job Title Company
*Spouse
*Child 1
*Child 2
*Child 3
Father
Mother
*Sibling 1
*Sibling 2
*when applicable

C. Health History
1. Have you had rather severe illness/accident? If yes, please describe Month/Year

2. Does it a side effect presently? If yes, please describe

II. EDUCATION AND SKILLS

A. Formal Education
Education Institution's Name Major From To GPA
High School
Academy
University

B. Non Formal Education (Courses, Training, Seminars, Etc)

Field/ Kind Conducted by Whom Year/Period Paid By
 1
2

C. Languages
Language Listening Speaking Writing
1
2

D. Hobbies / Sports

III. WORK EXPERIENCE (two latest experiences)

Month/Year Company: First Position:

From: Address: Last Position:
To: Phone: Net Salary/Month:
Line of Business: Name of Supervisor:

Month/Year Company: First Position:

From: Address: Last Position:
To: Phone: Net Salary/Month:
Line of Business: Name of Supervisor:

IV. CURRENT / LAST SALARY & BENEFITS

Basic Net Monthly Salary: Medical:

THR:
Bonus:
Commissions: Others:
Allowances: Meal
Transport

V. SALARY AND COMMENCEMENT OF EMPLOYMENT

Desired monthly income

Earliest date available to begin work

VI. OTHERS

1. Will you be available and willing for overtime work?

2. Will you be prepared to work under pressure?

I hereby declare that the statements made on this documents are true and correct
Saya dengan ini menyatakan bahwa informasi yang saya berikan diatas adalah benar dan tepat adanya.

Jakarta, _______________
Full Name : ________________________