APPLICATION FORM

Please Note:

1. Please PRINT clearly.

2. Please ask for additional sheets of paper if necessary.
3. Please attach to this application, 1 – 4x6 cm photo along with your CV and a
photocopy of your ID
4. If the information written in this application is untrue, Company retains the right
to cancel the employment agreement.

Position Applied for: Teacher

Name of Applicant: Dewi Zulviana

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A. PERSONAL DATA
1. Complete Name: Dewi Zulviana Darius
2. Address: Jalan Sawo No.12A Cipete-Utara Keb-Baru JakSel 12150

Permanent resident ( x ) Temporary ( )

3. Telephone: (H) 081286864559 ( HP )
4. Email: dewizulviana.d@gmail.com
5. Place & Date of Birth: Palu 10 November 1978
6. Religion: Islam
7. Nationality: Indonesian
8. Marital Status: Divorced
9. Spouse: Name Age Occupation
10. Children: - # Ages:

11. Identity Card No. / 3174075011780007

Work Permit No:

12. Passport No: X825084

13.Name of your biological
Mother: Salmiati

B. EDUCATIONAL BACKGROUND
1. FORMAL

Level School City Faculty Graduation Date

Senior High School Al Azhar Jakarta 1993-1996

Academy/College -

University Trisakti Jakarta 2005

2. ADDITIONAL/INFORMAL QUALIFICATIONS

Type Institution City Year Remarks

Advanced
John Robert
Personality Jakarta 2002
Powers
Development
Advanced Public John Robert
Jakarta 2002
Communication Powers
Australia
Teaching &
International Jakarta 2009
Learning Styles
School

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 TBI (The
CELTA British Jakarta 2009
Institute)
Medic One
Child Care First Aid
Training Jakarta 2012
Training
Centre
Certified Body Les Mills
Jakarta 2018
Combat Instructor Asia Pacific
3. LANGUAGE PROFICIENCY
Please indicate level of proficiency: Excellent, Good, Fair

Language(s) Known Listening Reading Speaking Writing

1. English Good Good Good Good
2. Indonesian Excellent Excellent Excellent Excellent
3.

4. WORK EXPERIENCE
Approx.
Name of Company Position Held Year Reason
Salary
1. Self Private tuition 2011-
employed teacher current
Pre Nursery
2. Kinderfun 2018-2020
teacher
3. Ivy League
K1 teacher 2015-2016
Academy
4. I Can Read Teacher 2010-2011
5. Pamong Sito
K2 teacher 2011-2012
Preschool
6. Australia Teaching
2007-2009
School Assistant
7. New Zealand Teaching
2006-2007
School Assistant

1. Describe what you enjoy(ed) about your current or most recent employment
position held?
I always love teaching whether now or back then, because it’s my passion.

2. Describe your duties and responsibilities in the company where you

work(ed).

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 To help children develop what they are capable of, because each child has
his / her own way to grow and to learn.

3. Draw the Organizational Structure in the company where you are currently
working or the previous company where you worked.

E. OTHER INVOLVEMENTS
1. Please list areas of involvement (formal/informal):
Name of Organization Position Held Activity Year
1.
2.
2. Hobbies:
Reading, exercising, cooking, browsing internet for some ideas
3. Do you read: A lot ( x ) Fair ( ) A little ( )
Topics that you enjoy reading:
Current news
4. Newspapers/Magazines that you read: Browsing internet for some current news

F. RELATED INFORMATION

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1. How did you hear about our company?
Website

2. Why do you wish to work in our company? Why do you wish to move from
the organization where you are presently employed?
Because I want to do what I am capable of, my passion, which is teaching.
Teaching in the school means everything is structured, binding and commited.

3. Are you employed (self or other) beyond your primary employment? If yes,
please describe Yes ( x ) No ( )
Private tuition teacher
4 Do you give your consent for us to contact previous employers?
Yes ( x ) No ( )
5. Have you ever had a serious sickness/surgery/accident?
If yes, please describe: Yes ( x ) No ( )
I was tested positive for covid back in June. I am fully Pfizer’d now.
6. Do you regularly take medication? If yes, please explain.
Only vitamins
7. Are you looking for a part-time or a full-time job?.
□ Part-time □ Full-time
8. If the company needed to send you out of town, would you be willing to go?
No, due to covid situation at the moment.
9. Are you willing to work on Saturday?
It depends, if I have a very important meeting or occasion then I won’t be
available
10. What salary and benefits do you expect?
Rp 5,000,000 (five million rupiah)

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11. When could you start working?
December 27, 2021
12. Do you have any acquaintance(s) or relative(s) employed by our company?
Please mention name and your relationship!
I have a gym friend named Liz Syamsudin,and she worked at Kinderland
Pakubuwono. She now lives in Malaysia.
13. Have you previously applied to our company? If so, when and what position?
No
14. Please list at least three persons (non-relatives) who could be contacted as
references
Name of
Name Phone No. Relationship Occupation
Company
1. Marisa Student’s
085810228412
Hadiwijoyo parent
Former
085720174079 academic
2. Nicole Pilliod / advisor at Ivy
081394575749 League
Academy
Teacher at
3. Ellis Foster 087880252222 Australian
School

I hereby confirm that all information given in this application is true.

Name: Dewi Zulviana Darius

Date: Monday, Dec 20, 2021

Signature: