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APPLICATION FORM

EVALUATION RESULT (For HR Department Only)

TOTAL RATE Comment


HIRED ________________________________________________________________
FOR FINAL INTERVIEW ________________________________________________________________
FOR FURTHER EVALUATION ________________________________________________________________
FAILED ________________________________________________________________

Please write the information legibly and in printed form. Put N/A if the needed information is not available.

Position Applied : Senior Business Development


Current salary (THP) : Rp 8.000.000 Expected salary (THP) : Rp 10.000.000
Contact Number : 081239669039 Email : Vickytandya@gmail.com
How did you know about VENTENY INC.?
□ Jobstreet □ TechInAsia х LinkedIn □ Others (Please specify) : _____________________________________

Full Name : Vicky Tandya Lolo Brygida Tandya


First Name Middle Name Last Name Nick Name

Current Address : Jalan Pulau Bidadari III Blok B 3 No 32


Date of Birth : July, 16th 1998 Age : 25
Sex :M/F Religion : Islam
LinkedIn : www.linkedin.com/in/vickytandya

Marital Status
Spouse’s Full Name :- Occupation :-
Number of Children :-
Member of Family
Full Name Relationship Occupation

Yosua Melianus Father Businessman

Indah Suryani Mother Housewife

Cantara Zoe Maritza Sister Student


Contact Person in Case of Emergency
Full Name Relationship Contact Number

Indah Suryani Mother 087856501098

Anindita Zahra Workmate 089619202199

Educational Background
School Year Graduated GPA Degree

Udayana University 2021 3.7 Bachelor of Agriculture

Employment History (Start from the most recent one)


Company Job Title Duration Reason for Leaving
PT Pesta Pora Abadi Business Development 5 months Still in college
Mashayama Business Development 6 months Still in college
Zenius Business Development 8 months Challenge myself to
another industry
Lamudi Indonesia Sr. Client Relationship 1 Year 4 Months Currently working here
Officer and Sr. Business
Development

Health Condition
Do you have any current serious sickness / previous surgery? _____Yes __х__No
If so, please specify : -
References (Must fill at least 2 person)
Name Title Company Email / Phone Number
Anindita Zahra Client Relationship Officer Lamudi Indonesia
Leader 089619202199
Client Relationship Officer
Putu Ari Pramesty Gold Lamudi Indonesia 081999076141
Declaration
I hereby certify that all information written here are true and correct to the best of my knowledge. In case of any of the
above information is found to be false or untrue or misleading or misrepresenting, I am aware that I may be held liable
for it and will withdraw my application at Venteny Indonesia.

____________________
Signature

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