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APPLICATION FORM
(Write in Capital Letters)

Position Applied For EXPECTED SALARY Available Starting Date

STAFF COOK CAN START ON NOVEMBER

A. PERSONAL INFORMATION
PERSONAL DATA
Full name : RUSLI  Male  Female
Place / Date of Birth : PULAU SARPPO KEKE, 21 NOVEMBER 1994
Temporary Address :-

City :- Post code : - Telephone :-

Permanent Address : JE’NELIMBUA STREET, CAKURA, TAKALAR, SOUTH OF SULAWESI

Email Address :ruslyoqluedr21@gmail.com

City :TAKALAR Post code : 92252 Telephone : 0821 8731 5152
I.D. Card Number :7310030706940004 Date of Expiry : FOR LONG LIFE
Marital Status : SINGLE Number of Children :2
Religion : ISLAM Blood Group :-
Height / Weight : 165 Cm/ 45 Kg Hobby :FUTSAL
Distinguishing Marks :

FAMILY RECORD

Father Name SAHARUDDIN_______ Date of Birth 15-05-1971 Address TAKALAR__________

Mother Name HAPSA____________ Date of Birth 26-08-1972 Address TAKALAR__________
Husband/Wife Name ___________________ Date of Birth ________ Address _________________
Children Name 1 _________________Date of Birth ________
2 _________________Date of Birth ________
3 _________________Date of Birth ________
Brother/Sister Name SUARDI, RUDI, RISMA________ Address/Phone. TAKALAR/ 0813 4235 8843
Contact person in case of emergencies HAPSA__________ Address/Phone. TAKALAR/ 0813 4083 0625

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.

Signature


RUSLI___________