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Please complete the application in English. If there is no information to be given or a particular item does
not apply to you, please write "N/A" for Not Applicable.
1 ……………………………………………………… 2 ………………………………………………………..
Minimum Monthly Salary Desired …………………………………IDR/Month Date Available for Employment …../ ........ /……
♦ Personal Information
Date of Birth ......./……../……. Place of Birth ……………………………………….. Nationality …………….. Email …………………
Road …………………………………...……………………………………………….
Province ………………………………………………………….
♦ Current Address
Road …………………………………...…………………………………………………………
Province ………………………………………………………………
♦ Phone Number
Whatsapp No. ……………………………. Mobile Phone No. …………………………… Mobile Phone No. …………………………….
♦ Family Details
Family Members First Name - Last Name Age Occupation/Position Address/Office Telephone No.
Father
Mother
Sibling(s) 1.
2.
3.
4.
5.
Spouse
♦ Educational Background
High School
Commercial/Vocational/College
University
Others
♦ Previous Employment (Including Temporary Work and Practical Training) from present to past
Date/Month/Year
Previous Company's
Position Reason for Leaving
Name Salary
From To
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Indonesia
English
………………
………………
English Touch Typing (word/min.) .................. Computer Skills (Please specify programmes) ……………………………………………….....
♦ Other Data
1. Have you ever been or are you suffering from any physical impairment, or disease including any nervous/mental disorder?
Yes No
Please tick any of the following ailments you have now or have ever had within previous year.
7. Emergency contact
Name ………………………………………………… Relationship ……………………………………………………………...
Address ………………………………………………………………………………………………………………………………….......
Telephone Number ……………………………………………………….
8. Have you any relative working in this company (Family, friends, colleagues)? Yes / Name ……………………………………….
No
9. May inquiry be made of your present employer regarding your qualifications and character? Yes
No
10. Have you been certified by the Office of Skill Standard and Testing Development? (If yes, please specify and enclose certificate.)
I hereby confirm that all the answers and statements given by me on are true and correct in every aspect. However, should the
company employ me, and should it be found afterwards that any of the information given by me is false and inaccurate, I shall allow
the company to dismiss me from its employment immediately without any compensation.
I certify that I have not made and will not make any offering, directly or indirectly, of any gift, gratuity, favour, entertainment, loan or any
other thing of monetary value to obtain employment.
……../………/…….. ……………………………………..
Date Applicant's Signature