JOB APPLICATION FORM

I. APPLICANT PERSONAL DATA

POSITION APPLIED:
Research & Engineering Baby Care Staff
COMPLETE NAME / NICK NAME:
Muhammad Luthfie Zulkarnaen/Luthfie
ADDRESS (PERMANENT): 3x4
Jl. Sunda No. 22/34A RT.07/RW.07, Kel. Kebon Pisang, Kec. Sumur Bandung,
Kota Bandung
ADDRESS (TEMPORARY):
Kampung Sadang pabuaran RT.01/RW.01, Desa Barengkok, Kibin, Kab. Serang

 Male Height: Weight: Religion: Nationality:

 Female 164 cm 55 kg
Islam Indonesia
BIRTH PLACE: Bandung Date of Birth: April 14, 1998
MARITAL STATUS: No. ID Card / Passport:
 Single  Widow / Widower Driving License: No. Driving License:
(A/B/C)
 Married  Divorce
No. of Chidren: - Telephone no: - Email address:
Handphone no: 081573754894 Luthfiezulkarnaen@gmail.com
SOCIAL MEDIA ACCOUNT :
LinkedIn : Muhammad Luthfie Zulkarnaen Twitter :-
Instagram : Luthfie Zulkarnaen Facebook :-
Others :-

II. EDUCATION (PLEASE WRITE DOWN ALL)

A. Formal Education
Education Level School Name Major PERIOD GPA DEGREE
1. Elementary School SD Negeri Gambir - 2003 to 2009 23,71

2. Junior High School SMP Negeri 5 Bandung - 2009 to 2012 33,91

3. Senior High School SMK Negeri 5 Bandung Chemical 2012 to 2016 36,14 D1
Analyst
4. Undergraduate Institut Teknologi Chemical 2016 to 2020 3,21 S1
Nasional Engineer
5. Post Graduate ….. to …..
6. Others
B. Informal Education (Seminar/Training)
Informal Education Name Period
1. Polymerization 2018

PT Softex Indonesia
Head Office : The Prominence Tower, 5th Floor, Jl. Jalur Sutera Barat No.15, Alam Sutera, Tangerang, Banten 15143, Indonesia. T (6221) 3005 5108
Factory : Kawasan GT Tech Park Kav. 6-7, Komplek Industri Bintang Puspita Dwikarya, Wanasari, Karawang, Jawa Barat 41361, Indonesia. T (6221) 8060 4282
Komplek Industri dan Pergudangan Safe n Lock, B-2, Jl. Lingkar Timur, Rangkah Kidul, Sidoarjo, Jawa Timur 61234, Indonesia. T (6231) 5820 4767
No. Dokumen : FR – HR – 005
Revisi : 02
 2.
3.
C. Organization Activities
Organization Name Position Period
1. Himpunan Mahasiswa Teknik Kimia Head of PSDM 2019-2020
2. Veloxymic Chem-E-Car Head of Equipment 2017-2020
3.
4.
D. English Proficiency
English Proficiency Name Score Period Issued By
1. TOEFL 503 2019-2020 ITENAS
2. IELTS
3. Others
HOBBIES: LANGUAGE:
1. Futsal 1. Indonesia
2. Read a Book 2. English
3. Watching anime 3.

III. FAMILY (PLEASE INCLUDE YOURSELF)

Birth of CURRENT JOB

SEX LAST
RELATION NAME Date
(M/F) EDUCATION
(dd/mm/yy) Position Company
Father Zoelkarnaen M June 8, 1969 Junior High - -
School
Mother Refnis F October 7, Undergraduate Teacher MI
1968 Muhammadiyah
2
Father in law - - - - - -
Mother in law - - - - - -
Brother/Sister Daud Ali M October 15, Senior High Student Institut
1 Zulkarnaen 2003 School Teknologi
Nasional
Bandung
Brother/Sister
2
Brother/Sister
3
Brother/Sister
4
Wife/Husband
Child 1
Child 2
Child 3
Child 4
Others

PT Softex Indonesia
Head Office : The Prominence Tower, 5th Floor, Jl. Jalur Sutera Barat No.15, Alam Sutera, Tangerang, Banten 15143, Indonesia. T (6221) 3005 5108
Factory : Kawasan GT Tech Park Kav. 6-7, Komplek Industri Bintang Puspita Dwikarya, Wanasari, Karawang, Jawa Barat 41361, Indonesia. T (6221) 8060 4282
Komplek Industri dan Pergudangan Safe n Lock, B-2, Jl. Lingkar Timur, Rangkah Kidul, Sidoarjo, Jawa Timur 61234, Indonesia. T (6231) 5820 4767
No. Dokumen : FR – HR – 005
Revisi : 02
 IV. EMPLOYMENT HISTORY

A. Last /Current Employment:

Joined date: November 2, 2020 Company’s name: PT. Indowira Putra Paint Factory
Resigned date: April 19, 2022 Core business: Paint Industry
Start designation: May 1, 2021 Tel. no: (022)6030419
Last designation: April 19, 2022 Address: Jl. Industri II No. 5, Kota Cimahi
Supervisor’s name: Adriani Djajaprasetya Director’s name: Mr. Kinsley Wangsa Wijaya
Reason for leaving: Get the opportunity to Latest salary: Rp. 3.800.000
work at PT. Avia Avian Tbk

Facility(s)/Benefit(s) (details): food Others:

allowance, transportation allowance,
medical allowance, retirement allowance

B. Employment:

Joined date: May 17, 2022 Company’s name: PT. Avia Avian Tbk
Resigned date: August 11, 2023 Core business: Paint Industry
Start designation: November 17, 2022 Tel. no: (0254)768021
Last designation: August 11, 2023 Address: Jl. Raya Serang Km 60 Kawasan
Pancatama 5
kav 5, Kab Serang
Supervisor’s name: Dessy Septiana Director’s name: Angelica Tanisia Jozar
Reason for leaving: Want to find new Latest salary: Rp. 6.000.000
challenges and want to get better career
opportunities

Facility(s)/Benefit(s) (details): food Others:

allowance, transportation allowance,
medical allowance, retirement allowance.

C. Employment:

Joined date: Company’s name:

Resigned date: Core business:
Start designation: Tel. no:
Last designation: Address:
Supervisor’s name: Director’s name:

PT Softex Indonesia
Head Office : The Prominence Tower, 5th Floor, Jl. Jalur Sutera Barat No.15, Alam Sutera, Tangerang, Banten 15143, Indonesia. T (6221) 3005 5108
Factory : Kawasan GT Tech Park Kav. 6-7, Komplek Industri Bintang Puspita Dwikarya, Wanasari, Karawang, Jawa Barat 41361, Indonesia. T (6221) 8060 4282
Komplek Industri dan Pergudangan Safe n Lock, B-2, Jl. Lingkar Timur, Rangkah Kidul, Sidoarjo, Jawa Timur 61234, Indonesia. T (6231) 5820 4767
No. Dokumen : FR – HR – 005
Revisi : 02
 Reason for leaving: Latest salary:

Facility(s)/Benefit(s) (details): Others:

How did you know PT. Softex Indonesia?

References:
Name Phone No. Relation Occupation & Company

Emergency Contact:
Name Phone No. Relation Occupation & Company

Please state your expected salary: Rp. 7.000.000 to 8.000.000

Please explain your job description and responsibility in current position

A company that produces care products for babies, care for women, and care for the elderly

V. QUESTIONS

QUESTIONS YES NO REMARKS

1. Have you ever been sick for more than 7 No
consecutive days in the last 2 years? If yes,
please state your disease!
2. Have you ever been involved in criminal case No
or politics, which causes you to be detained
by the enforced or be punished? If yes,
please explain!
3. Do you have a private vehicle? If yes, please Yes A motocycle
state!

PT Softex Indonesia
Head Office : The Prominence Tower, 5th Floor, Jl. Jalur Sutera Barat No.15, Alam Sutera, Tangerang, Banten 15143, Indonesia. T (6221) 3005 5108
Factory : Kawasan GT Tech Park Kav. 6-7, Komplek Industri Bintang Puspita Dwikarya, Wanasari, Karawang, Jawa Barat 41361, Indonesia. T (6221) 8060 4282
Komplek Industri dan Pergudangan Safe n Lock, B-2, Jl. Lingkar Timur, Rangkah Kidul, Sidoarjo, Jawa Timur 61234, Indonesia. T (6231) 5820 4767
No. Dokumen : FR – HR – 005
Revisi : 02
 4. Do you have a family/acquaintance who No
works in PT. Softex Indonesia that willing to
take responsibilities of your
actions/statements? If yes, please write
down his/her name and your relationship
with him/her!
5. Are you willing/capable to work in PT. Softex Yes
Indonesia with the conditions below:
a. Undergo 3 months’ probation period
b. Obey all rules that have been made and
will be made by the company/supervisor
c. Will not demand:
i. Transport fee from and to the
office
ii. Housing from the company
d. Willing to be placed anywhere/any
positions according to the company’s
needs/decision
6. Please describe yourself with your own words, try to be as objective as possible without
explaining your background (education, experience, etc.). For example, try to explain by
answering these questions: What is the most important thing in your life? What are your
ambitions/goals? What motivates you? What is the foundation for your moral and ethics?
What other people’s opinions about you?
I am a diligent person, have good analytical skills, easy to adapt, and can communicate well.
The most important thing in my life is how can I make my parents happy and that motivates
me to keep working hard and always growing. The moral foundation that I always hold is
to always be honest and always be on time in doing anything. people see me as a friendly
and responsible friend.

I hereby state that the above information is correct and true, and with this I state that if one day the
data/answer I have given are wrong, I will get my punishment according to the company’s regulations.
And I am willing to be fired/dismissed without demanding anything from the company, if I violate the
company’s regulations and/or the consequences of my actions are not reasonable and endanger the
company according to the company during the probation or after the probation period.

Bandung, 29/082023

______________________________

(Muhammad Luthfie Zulkarnaen)

PT Softex Indonesia
Head Office : The Prominence Tower, 5th Floor, Jl. Jalur Sutera Barat No.15, Alam Sutera, Tangerang, Banten 15143, Indonesia. T (6221) 3005 5108
Factory : Kawasan GT Tech Park Kav. 6-7, Komplek Industri Bintang Puspita Dwikarya, Wanasari, Karawang, Jawa Barat 41361, Indonesia. T (6221) 8060 4282
Komplek Industri dan Pergudangan Safe n Lock, B-2, Jl. Lingkar Timur, Rangkah Kidul, Sidoarjo, Jawa Timur 61234, Indonesia. T (6231) 5820 4767
No. Dokumen : FR – HR – 005
Revisi : 02